313621361-11-5-2021-03-CC-KPES-C8SN68-20211115091042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 313621361
Report Date: 11/05/2021
Date Signed: 11/05/2021 01:00:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2021 and conducted by Evaluator Jeremey McClain

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20211014095207

FACILITY NAME:	GODDARD SCHOOL, THE (PS)		FACILITY NUMBER:	313621361
ADMINISTRATOR:	HANNAH SIMMONS		FACILITY TYPE:	850
ADDRESS:	2021 WILDCAT BLVD		TELEPHONE:	(916) 778-6620
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	132	CENSUS: 89	DATE:	11/05/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Milli Naik		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Lack of supervision resulted in a child in care being injured.

INVESTIGATION FINDINGS:

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On November 5th,2021, Licensing Program Analysts (LPAs) Jeremey McClain and Josiah Gathing met with Licensee Millie Naik to close a complaint investigation. LPAs observed 89 children supervised by 14 staff members in seven separate rooms. It was alleged that lack of supervision resulted in a child being injured in care. During the investigation, LPA conducted interviews, made observations at the facility, and reviewed documents related to the incident. While it was clear that a child suffered an injury while in care, there was insufficient evidence to support that the injury was due to a lack of supervision from staff. The preponderance of evidence standard has not been met, therefore, the allegation is determined to be unsubstantiated.

There were no Title 22 deficiencies during today’s investigation. LPA reviewed this report with Licensee and provided a Notice of Site Visit that must be posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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