073407400-11-15-2022-52-CC-MPRE-CL7VRG-20221115153954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407400
Report Date: 11/15/2022
Date Signed: 11/15/2022 03:40:08 PM

Document Has Been Signed on 11/15/2022 03:40 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GODDARD SCHOOL, THE		FACILITY NUMBER:	073407400
ADMINISTRATOR:	INGRID ESCALANTE		FACILITY TYPE:	830
ADDRESS:	100 GATEKEEPER RD		TELEPHONE:	(925) 560-9694
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	53	CENSUS: 8	DATE:	11/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Steven Nguyen & Anju Khemani		TIME COMPLETED:	03:37 PM

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On 11/15/2022 at 9:30am Licensing Program Analyst (LPA) Morgan Pringle met with Facility Staff member Steven Nguyen and facility Owner, Anju Khemani, for an Unannounced Annual Inspection. The facility Director was out during LPA’s inspection and the facility owner, Anju Khemani, arrived at 9:40am. During the inspection eight (8) infants and five (5) staff were present. Two classrooms (Puffins and Hummingbirds) were toured for a health and safety inspection. The facility operates from 7:30am – 5:30pm, Monday – Friday and has a Toddler option. The facility holds a license for Preschool, Facility #073407398 and school age, Facility #75700605 as well.

The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. All sinks are observed to be clean and in proper working order. All cribs are clean and free from all hazards. The changing area is properly cushioned and well maintained. All infants have an Individual Infant Sleeping Plan (LIC9227) as well as an updated Needs and Services Plan. All children have access to clean drinking water in the classroom and outside as well. The kitchen is clean, well maintained, and all hazards are in inaccessible areas. All medications are properly maintained, documented and stored at the facility. There are carbon monoxide and smoke detectors on site and a fully charged fire extinguisher on site. The outside play yard is fully fenced, clean, and free from hazards with plenty of shade. The play structure is sturdy and properly maintained. LPA did not observe any harmful or unattended bodies of water in or around the facility.

Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GODDARD SCHOOL, THE	FACILITY NUMBER: 073407400
	VISIT DATE: 11/15/2022

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Owner was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Owner Anju Khemani.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GODDARD SCHOOL, THE	FACILITY NUMBER: 073407400
	VISIT DATE: 11/15/2022

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The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible in the entry way of the facility. The fire/disaster drill log was is complete with the last drill logged on 10/10/2022. A physical census of the children and staff was taken and cross referenced with the sign-in and out log. All children were properly signed in and accounted for by their authorized representative. All staff have obtained a criminal record clearance. LPA obtained the facilities files, children’s files and staff files. All files were complete.

Owner was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Owner was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Owner that all forms can be downloaded at www.ccld.ca.gov. Owner was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GODDARD SCHOOL, THE	FACILITY NUMBER: 073407400
	VISIT DATE: 11/15/2022

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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Owner Anju Khemani.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC809 (FAS) - (06/04)

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