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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407400
Report Date: 05/24/2019
Date Signed: 05/24/2019 03:47:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
073407400
ADMINISTRATOR:PAULO, JENAFACILITY TYPE:
830
ADDRESS:100 GATEKEEPER RDTELEPHONE:
(925) 560-9694
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:53CENSUS: 24DATE:
05/24/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Anju KhemaniTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Cherie Acosta and Julia Placencia conducted an unannounced case management inspection to amend the annual random inspection report from 5/14/19. The report from 5/14/19 did not include the children in the toddler option on the original report. The toddler option children were mistakenly counted on the preschool license.

During today's inspection there were 6 staff and 24 children present. Of the 24 children present today 14 children were in the toddler option.

There are no deficiencies cited today.
Appeal rights given.
Exit interview conducted with Anju Khemani
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 856-6376
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
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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