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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343617610
Report Date: 07/24/2024
Date Signed: 07/24/2024 11:41:38 AM

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
07/19/2024 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240719163958
FACILITY NAME:MERRYHILL SCHOOL - POCKETFACILITY NUMBER:
343617610
ADMINISTRATOR:SUSAN FREITAGFACILITY TYPE:
850
ADDRESS:7335 PARK CITY DRIVETELEPHONE:
(916) 424-2299
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:170CENSUS: 102DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Terrie CookTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility did not ensure that playground equipment is cushioned.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christopher Bello met with Principal, Terrie Cook to open and close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed 102 children. LPA made observations, gathered documents pertaining to the investigation and conducted interviews. It was alleged that the playground had a balance beam without proper padding to prevent injury. LPA observed that there was not sufficient padding to prevent an injury. The facility self-reported the incident to the Sacramento Regional Office. Director stated that she reported the incident to the regional office and issue will be corrected as soon as possible. Based on LPA’s investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED.

Title 22 deficiencies are cited on the subsequent page of this report. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Principal.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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 2
Control Number 03-CC-20240719163958
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 - POCKET
FACILITY NUMBER: 343617610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2024
Section Cited
CCR
101238.2(e)
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As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. This has not been met by evidence: LPA observed lack of padding underneath balance beam. This is considered as a potential risk
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Principal stated that they will get sufficient padding for the balance beam by POC date: 8/23/24. LPA will return to clear the deficiency.
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to the children 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.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2