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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700605
Report Date: 08/06/2021
Date Signed: 08/06/2021 01:09:11 PM

COMPREHENSIVE INSPECTION
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:
075700605
ADMINISTRATOR:INGRID ESCALANTEFACILITY TYPE:
840
ADDRESS:100 GATEKEEPER ROADTELEPHONE:
(925) 577-6001
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:30CENSUS: 0DATE:
08/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Ingrid Escalante and Anjum KhemaniTIME COMPLETED:
01:10 PM
NARRATIVE
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On 8/6/2021 at 11:40am Licensing Program Analyst (LPA) Morgan Pringle met with Owner Anju Khemani and Director Ingrid Escalante for an unannounced annual inspection. No children were present during the inspection. The school was currently open, but it was an "in-service" day. There were twenty-one (21) teachers present during the inspection. One (1) classroom was toured for a health and safety inspection.

The facility has age appropriate materials that were observed to be clean and in good condition. All outdoor spaces have proper shading for children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. All sinks and toilets were observed to be clean and in proper working order. The kitchen/food preparation area was observed to be clean. LPA did not observe any bodies of water at the facility.

LPA obtained the facility roster and a sample of the children’s files and the staff files. All children’s files were observed to be complete. All staff files were complete. File and disaster drill log was obtained and the last drill was logged on 7/22/2021.

Director was reminded that ALL staff and adults, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3,000 per person, per incident. Director was reminded of the responsibility as a mandated reporter.

All fire/disaster drill must be conducted every six months and documented. The Director is reminded that any structural changes to the facility or additions to the childcare facility must be reported to Community Care Licensing.

Cont on 809-C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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
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: 08/06/2021
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Director was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Director for a signature. There are no deficiencies being cited today. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
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