075700605-8-13-2019-52-CC-PPEN-BEZUVE-20190813155503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 075700605
Report Date: 08/13/2019
Date Signed: 08/13/2019 03:55:41 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, THE		FACILITY NUMBER:	075700605
ADMINISTRATOR:	KHEMANI, ANJU		FACILITY TYPE:	840
ADDRESS:	100 GATEKEEPER ROAD		TELEPHONE:	(925) 577-6001
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	30	CENSUS: 0	DATE:	08/13/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Kelly Reinbolt/Anju Khemani		TIME COMPLETED:	03:50 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	Licensing Program Analyst (LPA) Paul Petersen conducted an announced pre-licensing site inspection for this facility on 08/13/19. LPA met with director, Kelly Reinbolt, and applicant, Anju Khemani. An inspection for this facility including the preschool areas and outdoor areas was previously conducted on 08/09/19. An application has been submitted for a new school age license for this facility. The school-age program will be operating in one room (Hawks Classroom). The program is a school age component of a combination center with a preschool and infant program with toddler component also on site. Hours of operation will be from 7:00 AM to 6:00 PM. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 1207.5 square feet = 34 children OUTDOORS: 5620.54 square feet = 75 children The facility has a working carbon monoxide detector and there is a fire inspection clearance approved by San Ramon Fire Protection Department for capacity of 30 school age children. There are a total of 3 toilets and 3 sinks available to children in care. The facility has centralized smoke detector/fire alarm system and carbon monoxide detector. The school-age program will use the preschool/school age outdoor play areas including the basketball court and the playground area with no commingling of children from the other age groups. The outdoor play area is fenced in all around and the climbing structures are age appropriate and securely anchored. There is shade available for the children in the outdoor play area. There are no pools or other accessible bodies of water present. A waiver is on file for shared outdoor play use. The classroom is equipped with age appropriate materials and equipment. The staff bathroom and the office will be used as isolation areas for sick children. Drinking water is available inside via water pitcher and cups and outdoors via water fountain. The center has first aid supplies available. Continued on Page 2**************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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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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: 075700605
	VISIT DATE: 08/13/2019

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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.

Kelly Reinbolt is a qualified director with and has completed 16 hours of health and safety training including pediatric CPR and First Aid.

Licensee is encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact: ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

The center is found to be clean, safe, sanitary, and in good repair.

A license for 30 preschool age children has been issued effective 08/12/19. An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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