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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617609
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:51:20 PM

Document Has Been Signed on 10/28/2021 01:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MERRYHILL SCHOOL-POCKETFACILITY NUMBER:
343617609
ADMINISTRATOR:FREITAG, SUSANFACILITY TYPE:
830
ADDRESS:7335 PARK CITY DRIVETELEPHONE:
(916) 424-2299
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 36TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Susan FreitagTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:50am to conduct an unannounced annual random inspection for the infant program. LPA met with Director Susan Freitag. LPA began touring the facility at approximately 9:00am. The infant indoor and outdoor activity space is physically separate from the space used by other day care children. Infant furniture and equipment, including cribs, cots/mats, and feeding chairs are enough, age appropriate and in good repair. Infant changing tables have padded surface no less than one inch thick, covered with washable vinyl or plastic, and have raised sides at least three inches high. Toys are safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed. Facility follows staff infant ratios. All infants including those napping in cribs are always under visual observation. Feeding plans reviewed for some infants. Needs and Services plans reviewed for some infants. Sign in/Sign out sheets have full legal signature and record of time of day. Staff utilized as infant teachers have three child development units in infant/toddler care. There are no bodies of water on the premises. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Fire drills are conducted every month and documented. Rooms are safe and clean. The facility is in compliance with conditions and limitations specified on the license. All staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience and, a Health Screening/TB test and immunization records to meet SB 792. LPA observed that Staff #4 did not have the required LIC503 form at time of inspection.
Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
REPORT CONTINUES ON NEXT PAGE.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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 10/28/2021 01:51 PM - It Cannot Be Edited


Created By: Christopher Bello On 10/28/2021 at 11:37 AM
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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MERRYHILL SCHOOL-POCKET
FACILITY NUMBER: 343617609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2021
Plan of Correction
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The director will submit a copy of the Mandated Reporter Training to LPA by POC date 11/29/21 for Staff #1, #2 and #3.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2021
Plan of Correction
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The director will submit a copy of the LIC503 to LPA by POC date 11/29/21 for Staff #1.
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:Roxana Saravia
LICENSING EVALUATOR NAME:Christopher Bello
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MERRYHILL SCHOOL-POCKET
FACILITY NUMBER: 343617609
VISIT DATE: 10/28/2021
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
LPA did not observe current Mandated Reporter Training on file at time of inspection, this is considered a potential risk to the children in care. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: HTTP://WWW.MANDATEDREPORTERCA.COM/. The training is currently provided in English and is approximately six to seven hours long. AB1207 Training.
LPA checked facilities fees and confirmed that it is up to date.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations.

LPA advised licensee to sign up for the quarterly updates provided by the Childcare Advocates Program. LPA provided the link https://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the licensee to sign up for the updates.

REPORT CONTINUES ON NEXT PAGE.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MERRYHILL SCHOOL-POCKET
FACILITY NUMBER: 343617609
VISIT DATE: 10/28/2021
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, deficiency was observed at the time of the visit and cited on LIC 809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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