<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621361
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:34:43 PM


Document Has Been Signed on 09/20/2023 12:34 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:GODDARD SCHOOL, THE (PS)FACILITY NUMBER:
313621361
ADMINISTRATOR:SHARMILI NAIKFACILITY TYPE:
850
ADDRESS:2021 WILDCAT BLVDTELEPHONE:
(916) 778-6620
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:132CENSUS: 100DATE:
09/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ash and Millie NaikTIME COMPLETED:
12:30 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
On September 20, 2023, Licensing Program Analyst (LPA) Jeremey McClain met with Licensees Ash and Millie Naik for an unannounced Case Management Inspection regarding an Unusual Incident Reported.

LPA observed care and supervision of 100 preschool and toddler aged children by 13 staff between seven different classrooms.

On September 18, 2023, it was reported that a child cut their lip after they tripped and fell face first on the steps of a play structure outside. Staff applied pressure to stop the bleeding, applied ice, and contacted the child's parents. The child later received stitches after being taken to care. LPA made observations to the playground and equipment and also observed the incident via recorded footage.

LPA determined that the incident was not due to lack of supervision or hazards on the playground. No deficiencies were observed.

This report was reviewed with the Licensing Representative. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023
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 1