<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608219
Report Date: 02/15/2024
Date Signed: 02/15/2024 03:00:27 PM

Document Has Been Signed on 02/15/2024 03:00 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 - HARBOUR POINTFACILITY NUMBER:
343608219
ADMINISTRATOR:STEPHANIE GILLFACILITY TYPE:
850
ADDRESS:9561 HARBOUR POINT DRIVETELEPHONE:
(916) 683-3244
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 97DATE:
02/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Amanda TamanahaTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/15/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection. LPA arrived at the facility and was met by Assistant Director Amanda Tamanaha (D1). LPA disclosed the purpose of the inspection and was granted entrance. LPA noted the census of 92 preschool aged children. LPA determined through accessing Guardian that all required adults were background cleared and associated to the license.

Staff Member, T1, was rough with day-care children. Interviews and records revealed that on 08/09/2023, T1 dug her nails into a day-care child’s arms which resulted in marks and redness. Director Gil was provided a written statement by T1 acknowledging that T1 caused an injury to the day-care child. This injury and incident was not reported to the Department. The lack of reporting poses/posed a risk to the health, safety, and personal rights of person(s) in care. As a result, a Type-B deficiency was cited on a subsequent 809-D page.

An exit interview was conducted, and the report was reviewed with Assistant Director Tamanaha. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/15/2024 03:00 PM - It Cannot Be Edited


Created By: Katy Velazquez On 02/15/2024 at 02:18 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 - HARBOUR POINT
FACILITY NUMBER: 343608219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2024
Section Cited
CCR
101212

1
2
3
4
5
6
7
Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during
1
2
3
4
5
6
7
Director Gill will watch “Child Care Reporting Requirements” on the CCLD website. Director Gill will email LPA confirming that she watched the video in entirety by 5 PM 02/22/2024. A LIC 610A will be submitted via email to LPA by 02/22/2024.
8
9
10
11
12
13
14
its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department...
This requirement was not met as evidenced by a child receiving an injury on 08/09/2023 which was not reported to the Department.

8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2