343600372-11-21-2024-53-CC-KVEZ-DB8SP7-20241121130239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343600372
Report Date: 11/21/2024
Date Signed: 11/21/2024 01:02:55 PM

Document Has Been Signed on 11/21/2024 01:02 PM - 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	MERRYHILL SCHOOL - LAGUNA PARK		FACILITY NUMBER:	343600372
ADMINISTRATOR/ DIRECTOR:	DAVIES, MCKENZIE		FACILITY TYPE:	850
ADDRESS:	6613 LAGUNA PARK DRIVE		TELEPHONE:	(916) 684-4044
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY: 116	TOTAL ENROLLED CHILDREN: 116	CENSUS: 98	DATE:	11/21/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	McKenzie Davies		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/21/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a Case Management inspection as a result of a self reported Unusual Incident Report dated 11/18/2024. LPA arrived at the facility and was met by Director McKenzie Davies (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 98 preschool aged children being supervised by 11 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license. On 11/18/2024, 2 children was left unsupervised on the playground, for approximately 7 minutes, when the teacher(s) returned to their classroom. As a result, a Type-A deficiency was cited on a subsequent 809-D page. LPA informed Director Davies that this report, dated 11/21/2024, document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in-care. Also, LPA Velazquez informed D1 to provide a copy of this licensing report dated 11/21/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. LPA was able to clear the Type A citation while on site, and provided D1 with a letter of clearance. An exit interview was conducted, and the report was reviewed with Director Davies. LPA provided Licensee Appeal Rights to D1. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Karyn Guerra	TELEPHONE: (916) 216-7790
Katy Velazquez	TELEPHONE: 916-926-9100
	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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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Document Has Been Signed on 11/21/2024 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERRYHILL SCHOOL - LAGUNA PARK	FACILITY NUMBER: 343600372
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 11/22/2024
	Plan of Correction
1 2 3 4	Director Davies (D1) conducted a Preschool Staff Meeting on 11/20/2024 to review Face-to-Name procedures and supervision protocols. LPA provided D1 with a letter of clerance while on site.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Karyn Guerra	TELEPHONE: (916) 216-7790
Katy Velazquez	TELEPHONE: 916-926-9100
	DATE: 11/21/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC809 (FAS) - (06/04)

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