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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393615623
Report Date: 02/28/2024
Date Signed: 02/28/2024 01:54:30 PM

Document Has Been Signed on 02/28/2024 01:54 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERRYHILL SCHOOL - TRINITYFACILITY NUMBER:
393615623
ADMINISTRATOR:TAMARA WELLSFACILITY TYPE:
830
ADDRESS:10250 TRINITY PARKWAYTELEPHONE:
(209) 474-0518
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 26DATE:
02/28/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tammy WellsTIME COMPLETED:
03:00 PM
NARRATIVE
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On February 28th, 2024, at 10:00 AM, Licensing Program Analyst (LPA) David Nguyen and Licensing Program Manager (LPM) Chayntel Hunter conducted a case management inspection and met with Principal, Tammy Wells. LPA disclosed the purpose of the inspection, and both LPA Nguyen and LPM Hunter were granted entrance. LPA toured the facility and observed twenty-six (26) children present and being supervised by seven (7) adults.

During the complaint investigation, statements obtained through interview revealed there was a lack of supervision that occurred when S4 stood from her side of her room, and S4 faced away from the infants and recorded the interaction of another staff. S4 did not provide 100 percent supervision of the four infants while they were in her care, which poses an immediate risks to children in care.

It also revealed that S1 did not notify the Unusual Incident Report (UIR) to the Community Care Licensing Division (CCLD) within 24 hours, and S1 did not submit the written UIR to CCLD within 7 days, which poses a potential risks to children in care.

A Type A and a Type B violations were assessed on a subsequent 809-D page. Director shall post LIC 809-D with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensees.

A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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 02/28/2024 01:54 PM - It Cannot Be Edited


Created By: David Nguyen On 02/28/2024 at 12:42 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 - TRINITY
FACILITY NUMBER: 393615623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision... to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time,…
This requirement was not met as evidenced by:
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Staff Meeting will be held to focus on Supervision. Principal, Wells will email LPA Nguyen the sign-in sheet from this meeting. Principal, Wells will create a written statement for staff to sign that describes children’s supervision will be expected of staff for the future.
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Based on record review and interview, S4 stood from her side of her room, and S4 faced away from the infants and recorded the interaction of another staff. S4 did not provide 100 percent supervision of the four infants while they were in her care, which poses an immediate risks to children in care.
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Principal, Tammy Wells will email the signed statements to LPA Nguyen.

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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:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/28/2024 01:54 PM - It Cannot Be Edited


Created By: David Nguyen On 02/28/2024 at 12:54 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 - TRINITY
FACILITY NUMBER: 393615623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2024
Section Cited
CCR
101212(d)(1)(C)

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(d) Upon the occurrence…a report shall be made to the Department… A written report containing the information shall be submitted to the Department…(C) Any unusual incident…
This requirement was not met as evidenced by:
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Principal Tammy Wells will create a written statement and acknowledges that she does understand the reporting requirements when any unusual incident occurs at the child care center during the hours and days of operation.
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Based on record review and interview, S1 did not notify the UIR to CCLD within 24 hours and submit the written UIR to CCLD within 7 calendar days, which poses a potential risks to children in care.
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Principal, Tammy Wells will email the signed statement to LPA Nguyen.

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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:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


LIC809 (FAS) - (06/04)
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