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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621361
Report Date: 10/20/2021
Date Signed: 10/20/2021 05:24:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GODDARD SCHOOL, THE (PS)FACILITY NUMBER:
313621361
ADMINISTRATOR:HANNAH SIMMONSFACILITY TYPE:
850
ADDRESS:2021 WILDCAT BLVDTELEPHONE:
(916) 778-6620
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:132CENSUS: 70DATE:
10/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ashish and Millie NaikTIME COMPLETED:
02:30 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 October 20th, 2021, Licensing Program Analyst (LPA) Jeremey McClain met with Licensees Ashish and Sharmili Naik for an unannounced Case Management Inspection. The purpose of today’s inspection was to follow up on an Unusual Incident that was reported on October 6th, 2021.

LPA observed a census of 70 preschool children supervised by 12 staff members.

On October 6th, 2021 it was reported that Child #1 was left unsupervised in the Preschool 2 classroom by Staff #1, while the facility was conducting a fire drill. Child #1 was found unsupervised approximately 1 to 2 minutes before being brought to Staff #1 by another staff member. The child did not suffer any injuries.

Title 22 deficiencies are cited on the subsequent page of this report. If not corrected, these violations pose an immediate risk to the health and safety of children in care. Licensees acknowledge that upon receipt of a TYPE A DEFICIENCY, an LIC 9099-D with Type A deficiencies shall be posted for 30 days. Licensees also acknowledge that they must provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. LPA provided an LIC 9224, which Licensees understand must be signed by parents/guardians of children in care and parents/guardians of children newly enrolled at the facility during the next 12 months. Appeal Rights were provided.

This report was reviewed with the license. 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: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GODDARD SCHOOL, THE (PS)
FACILITY NUMBER: 313621361
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/21/2021
Section Cited

1
2
3
4
5
6
7
Responsibility and Providing Care and Supervision.(a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time.Supervision shall include visual observation. This requirment was not met as evidenced by the Unusual Incident Report that the licensee submitted on 10/6/2021.
8
9
10
11
12
13
14
Licensee reported that Child #1 was left in the Preschool 2 classroom when Staff #1 escorted the rest of the children out of the classroom during a fire drill on 10/06/2021.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2