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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617610
Report Date: 01/03/2023
Date Signed: 01/03/2023 09:20:30 AM

Document Has Been Signed on 01/03/2023 09:20 AM - 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:
343617610
ADMINISTRATOR:FREITAG, SUSANFACILITY TYPE:
850
ADDRESS:7335 PARK CITY DRIVETELEPHONE:
(916) 424-2299
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 170TOTAL ENROLLED CHILDREN: 170CENSUS: 143DATE:
01/03/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Terrie CookTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:30am and met with Director Terrie Cook for an unannounced Case Management Licensee Initiated inspection. Today’s inspection regarded inspection of a new play structure that was added to the facility. LPA inspected the play structure and observed that it was incompliance with Title 22 regulations and the Health and Safety Code. LPA approved the play structure for use. LPA toured the entire facility with the director.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2023
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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