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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371104
Report Date: 03/12/2020
Date Signed: 03/12/2020 01:15:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
304371104
ADMINISTRATOR:IRVING, JENNIFERFACILITY TYPE:
830
ADDRESS:20455 ALTON PARKWAYTELEPHONE:
(949) 393-1220
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:40CENSUS: 30DATE:
03/12/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Director, Irving JenniferTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced case management inspection in response to a self reported incident. LPA met with Director, Jennifer Irving who guided LPA on a tour of the facility. LPA observed 30 infant children with 10 staff members. During today's inspection staffing and capacity ratios were met. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/06/2020 an unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 03/06/2020, a parent reported they observed a staff member on the playground lifted a child waist high by the upper arm.



During the course of the inspection, LPA interviewed staff members, reviewed surveillance footage, reviewed a staff file and conducted a physical plant inspection. All staff interviewed denied ever observing the staff in question, or any other staff, lifting any child by the arm. All staff interviewed stated that the staff in question is very caring, loving and very dedicated to her job. LPA viewed the outside video surveillance at the facility for 03/06/2020. The video surveillance reviewed for 03/06/2020 did not show the teacher in question lifting the child in question by the arm but instead was guiding the child by the arm for the child to walk inside with the rest of the group.

Based on the staff interviewed, reviewed surveillance footage, reviewed staff file, and physical plant inspection, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the inspection.

Continued on Page 2
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 304371104
VISIT DATE: 03/12/2020
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Exit interview was conducted with Owner, Mehta Parina & Director, Irving Jennifer. Notice of Site Visit was posted during the inspection. Facility representatives was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Facility representatives was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
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