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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623338
Report Date: 12/28/2023
Date Signed: 12/28/2023 10:19:00 AM

Document Has Been Signed on 12/28/2023 10:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERRYHILL SCHOOL - ROCKLINFACILITY NUMBER:
313623338
ADMINISTRATOR:MELISSA MOENNINGFACILITY TYPE:
850
ADDRESS:5893 STANFORD RANCH ROADTELEPHONE:
(916) 624-4511
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 156TOTAL ENROLLED CHILDREN: 156CENSUS: 0DATE:
12/28/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Melissa MoenningTIME COMPLETED:
10:30 AM
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Licensing Program Manager (LPM) Keven Peters and Licensing Program Analyst (LPA) Jeremey McClain met with licensing representatives Melissa Moenning and Aubrey Larsen for the purpose of an Informal Office Meeting.
LPM Peters defined the difference between a Non-Compliance and an Informal Meeting. The purpose of today’s Informal Office Meeting was to discuss the Unusual Incident which occurred on 10/02/2023.
On 10/02/2023, Child #1 was using the restroom while during outdoor play. Staff #1 sent Child #1 to Staff #2, who was at the playground adjacent to Staff #1. Staff #2 supervised Child #1 at the bathroom that can be entered through from the playground. During this time Staff #1 stood at the gate that joins the playgrounds while she also supervised the remaining children on the playground. Staff #2 closed the door while the child was still in the bathroom after they thought they saw the child come out of the bathroom. Staff #1 immediately recognized that the child was not back, and asked the staff to check the bathroom again, where the child was found. The child did not suffer any injuries. It was estimated that the child was left alone in the bathroom for no longer than a minute. This incident was self-reported by the facility, and the child’s parents were notified immediately.
The following citations and regulations were discussed:
101229 (a)(1) Care and Supervision, Zero Tolerance, cited on 10/11/2023.
To stay in compliance, director has conducted a training with all staff regarding supervision requirements. Director has also required staff to take groups of children to bathroom while staying in ratio, instead of having sending children individually with a teacher. Staffing needs and qualifications were discussed.
LPM Peters informed licensing representative that continued deficiencies may result in further action, including a non-compliance meeting with the Regional Manager.
Although the facility is not considered high risk, LPM and LPA provided information regarding the Technical Support Program (TSP), which is a non-enforcement arm of the Community Care Licensing Division offering onsite support to licensees and providers. LPA McClain discussed using the Department website (ccld.ca.gov) for child care updates, current forms, legislation and regulation information. LPM Peters suggested that Licensee can view information videos at www.ccld.childcarevideos.org . This report was reviewed with licensing representative Melissa Moenning.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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