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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393615623
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:44:20 AM

Document Has Been Signed on 09/20/2021 11:44 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-TRINITYFACILITY NUMBER:
393615623
ADMINISTRATOR:TAMARA WELLSFACILITY TYPE:
830
ADDRESS:10250 TRINITY PARKWAYTELEPHONE:
(209) 474-0518
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 40TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
09/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tammy WellsTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Christopher Jackson and Chayntel Hunter met with facility representative Tammy Wells, for a Case Management Inspection. The purpose of today's inspection was to follow up on an Unusual Incident Report the Department had received on September 7, 2021.

LPAs toured the facility, observed the care and supervision of children, and conducted interviews with staff.

No title 22 deficiencies were cited during today's inspection. An exit interview was conducted and a notice of site visit was printed and posted.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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