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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614044
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:13:09 PM

Document Has Been Signed on 12/05/2024 03:13 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERRYHILL SCHOOL-DANBROOKFACILITY NUMBER:
343614044
ADMINISTRATOR/
DIRECTOR:		ROBIN KEMMERFACILITY TYPE:
830
ADDRESS:1901 DANBROOK DRTELEPHONE:
(916) 285-8656
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 3DATE:
12/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Margarita KnutsenTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On Thursday 5 December, 2024 at approximately 1:00 PM, Licensing Program Analysts (LPAs) Fabian Schwartz and Matthew Gallo met with Director Margarita Knutsen to close a complaint investigation. Upon arrival, there were 3 infants supervised by 2 staff.

During investigation into complaint, LPAs learned of an incident which occurred at the facility on 22 November 2024 at approximately 3:45pm. Incident was an unhoused man, who was naked, attempted to gain entrance into facility from the front doors, which were and are always locked. Facility immediately went into lockdown and called the police. Man was on the premises for approximately 30 minutes before police arrived and apprehended man. Director had to press charges against man due to incident.

This incident was not reported to the department as per licensing regulations. Due to this, facility is being cited a Type B citation for not reporting an unusual incident.

Type B citation is explained in more detail on accompanying LIC809-D page.

Notice of site visit was provided and must remain posted for 30 days. Exit interview was conducted with the director.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/05/2024 03:13 PM - It Cannot Be Edited


Created By: Fabian Schwartz On 12/05/2024 at 02:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERRYHILL SCHOOL-DANBROOK
FACILITY NUMBER: 343614044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2025
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.(1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

This requirement is not met as evidenced by:

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Director will submit an Unusual Incident Report to LPA Schwartz to report incident of naked man attempting to gain entrance to facility on 22 November 24 by 5 January 2025 to maintain compliance with licensing regulations.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above by not reporting an unusual incident to the department by required reporting timelines which poses/posed a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Amanda Blesi
LICENSING EVALUATOR NAME:Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
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