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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623339
Report Date: 10/21/2024
Date Signed: 10/21/2024 12:03:36 PM

Document Has Been Signed on 10/21/2024 12:03 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERRYHILL SCHOOL - ROCKLINFACILITY NUMBER:
313623339
ADMINISTRATOR/
DIRECTOR:		MELISSA MOENNINGFACILITY TYPE:
830
ADDRESS:5893 STANFORD RANCH ROADTELEPHONE:
(916) 624-4511
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 42DATE:
10/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Melissa MoenningTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Jeremey McClain met with facility representative Melissa Moenning for an unannounced Case Management Inspection regarding an Unusual Incident Report.

LPAs observed 42 children supervised by seven staff members.

It was reported that on 10/17/2024, 911 was called after C1 was unresponsive on the playground. The child had their eyes open at the time but was not responding. C1 was taken for medical attention where it was determined that C1 suffered a febrile seizure caused by a fever. During today’s inspection LPA reviewed C1’s file, conducted interviews with staff and discussed procedures moving forward with facility representative.

An exit interview was conducted, and the report was reviewed with facility representative Melissa Moenning. A Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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