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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343603513
Report Date: 07/03/2025
Date Signed: 07/03/2025 03:08:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2025 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20250505122941
FACILITY NAME:MERRYHILL SCHOOL - CALVINEFACILITY NUMBER:
343603513
ADMINISTRATOR:CLARISSA GARCIAFACILITY TYPE:
850
ADDRESS:9036 CALVINE ROADTELEPHONE:
(916) 689-7322
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:120CENSUS: 53DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kareina MedinaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not meet child’s toileting needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Velasco met with Facility Representative, Director Karina Medina (Director), for the purpose of conducting an unannounced initial complaint investigation inspection pertaining to the above allegations. The purpose of today's inspection was explained. During this investigation, LPA toured the facility, conducted interviews, and obtained relevant documentation.

Based on multiple witness statements, staff did supervise children while the children were toileting, but they may have on some occasions failed to adequately assist children with hygiene needs when the children were toileting. The preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. A Title 22 deficiency is being cited on continuation page LIC 9099D. An exit interview was conducted, and this report was reviewed with Facility Representative, Director Karina Medina. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 03-CC-20250505122941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERRYHILL SCHOOL - CALVINE
FACILITY NUMBER: 343603513
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2025
Section Cited
CCR
101229(a)
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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by multiple witness statements that staff did

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Director stated she will provide updated traiing to and supervision of all staff on meeting children's toileting and hygiene needs. Director stated she will email to LPA on or before the close of business on POC due date the training materials, sign-in sheet,
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not provide assistance with toileting as
needed, such that children were observed to have urine and/or fecal matter inside and/or on their clothing. This presents a potential health, safety, and/or personal rights risk to children in care.
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and documentaiton of extra oversight provided to staff.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2025 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20250505122941

FACILITY NAME:MERRYHILL SCHOOL - CALVINEFACILITY NUMBER:
343603513
ADMINISTRATOR:CLARISSA GARCIAFACILITY TYPE:
850
ADDRESS:9036 CALVINE ROADTELEPHONE:
(916) 689-7322
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:120CENSUS: 53DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kareina MedinaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff restrained child in care
Staff allowed child to leave the classroom without staff supervision
Staff did not prevent child in care from harming another child in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Velasco met with Facility Representative, Director Karina Medina (Director), for the purpose of conducting an unannounced initial complaint investigation inspection pertaining to the above allegations. The purpose of today's inspection was explained. During this investigation, LPA toured the facility, conducted interviews, and obtained relevant documentation.

Witness statements, LPA observations, and/or document reviews failed to corroborate the allegation that staff restrained a child in care. Witness statements and LPA observations showed staff held their hands in front of themselves for their own safety as needed, and staff placed their bodies between children to protect children from one another as needed, but staff did not restrain a child or children in care. Multiple witness statements were consistent in saying a child ran out of the classroom, but the teacher followed the child, leaving another staff in ratio with the children in the classroom, and multiple other staff blocked the child's exit and ensured the child was both supervised and safe in the facility.

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 03-CC-20250505122941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERRYHILL SCHOOL - CALVINE
FACILITY NUMBER: 343603513
VISIT DATE: 07/03/2025
NARRATIVE
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Continued from LIC 9099A.

Multiple witness statements were consistent in saying a child did bite another child, but staff were present, nearby, supervising closely, and staff intervened immediately to prevent injury to either child. Witness statements were also consistent in saying staff notified both parents, soothed the bitten child, and redirected the child who bit.

Although the allegations may have happened, there is not a preponderance of evidence to prove the allegations; therefore, the allegations are UNSUBSTANTIATED. Exit interview was conducted and report was reviewed with Facility Representative, Director Karina Medina. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4