434400320-9-16-2021-07-CC-SKNT-C72ULH-20210920154043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434400320
Report Date: 09/16/2021
Date Signed: 09/16/2021 10:39:08 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2021 and conducted by Evaluator Yangcheng Huang

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210708111229

FACILITY NAME:	MERRYHILL SCHOOL 1072		FACILITY NUMBER:	434400320
ADMINISTRATOR:	BILBRO, HEATHER		FACILITY TYPE:	850
ADDRESS:	750 NORTH CAPITOL AVENUE		TELEPHONE:	(408) 254-1280
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95133
CAPACITY:	117	CENSUS: 92	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Heather Bilbro		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Child was bitten by another Child

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced complaint investigation to the Facility today to deliver investigation findings. LPA met with Principal, Heather Bilbro, and explained the nature of today's visit to her.

Based on interviews of Pricipal, staff & complainant, reviews child, facility records & evidences, and LPA's own observations for the complaint allegation listed above.

LPA learnt that a child was bitten by another child on two consective days. These incidents were visually observed by the staff, but can not be stopped as occurred suddenly. The bitting incident was no longer occured therafter.

LPA therefore concludes that the preponderance of evidence standard has been met and the allegation listed above is therefore SUBSTANTIATED. Advisory Note is being issued on the attached LIC 9102s.

Exit interview conducted with Principal. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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