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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343615181
Report Date: 03/12/2021
Date Signed: 03/15/2021 11:04:10 AM



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
01/19/2021 and conducted by Evaluator Jan Hoshida
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210119145152
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
343615181
ADMINISTRATOR:LEE, KATELYNNFACILITY TYPE:
850
ADDRESS:10710 BEAR HOLLOW DRIVETELEPHONE:
(916) 861-0906
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:108CENSUS: 48DATE:
03/12/2021
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Katelynn LeeTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Personal Rights: Staff member used inappropriate language in front of day care children.
INVESTIGATION FINDINGS:
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On 3/12/21 at 3:15pm, due to the COVID-19 pandemic, Licensing Program Analyst (LPA), Jan Hoshida, conducted a tele-inspection via Zoom and met with Director, Katelynn Lee, to deliver findings and conclude the complaint investigation of the above allegation. LPA observed 48 children supervised by 7 staff.

The complainant alleged that a staff member used inappropriate language in front of day care children. During the investigation, LPA conducted a health and safety tele-inspection of the facility and interviewed pertinent parties.

Interviews revealed that a staff member used inappropriate language in front of day care children towards another staff member during a confrontation, but that the situation was defused, staff was removed and replaced with another staff within the classroom.

REPORT CONTINUED ON NEXT PAGE
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 03-CC-20210119145152
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
FACILITY NUMBER: 343615181
VISIT DATE: 03/12/2021
NARRATIVE
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Based on LPA's interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12) are being cited on the attached LIC 9099-D.

Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be given to each existing parent by the end of today or next day child is in care, and to the parent of children enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

An exit interview was conducted and Notice of Site Visit was provided to be posted for 30 days.
Facility evaluation report was emailed to Director and an email verification of receipt of report will be used in lieu of a signature on this report.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
01/19/2021 and conducted by Evaluator Jan Hoshida
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210119145152

FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
343615181
ADMINISTRATOR:LEE, KATELYNNFACILITY TYPE:
850
ADDRESS:10710 BEAR HOLLOW DRIVETELEPHONE:
(916) 861-0906
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:108CENSUS: 48DATE:
03/12/2021
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Katelynn LeeTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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9
Personal Rights. Staff member inappropriately disciplined day care children.
INVESTIGATION FINDINGS:
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On 3/12/21 at 3:15pm, due to the COVID-19 pandemic, Licensing Program Analyst (LPA), Jan Hoshida, conducted a tele-inspection via Zoom and met with Director, Katelynn Lee, to deliver findings and conclude the complaint investigation of the above allegation. LPA observed 48 children supervised by 7 staff.

The complainant alleged that staff member inappropriately handled day care children. During the investigation, LPA conducted a health and safety tele-inspection of the facility and interviewed pertinent parties.

Staff interviewed stated that for discipline for the children, they use redirection to encourage children to do a different activity, help children to calm down and never use time outs. Parents interviewed stated that they are happy with the care that their children receive, appreciate the staff and have not witnessed any inappropriate behavior from the staff.
REPORT CONTINUED ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 03-CC-20210119145152
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
FACILITY NUMBER: 343615181
VISIT DATE: 03/12/2021
NARRATIVE
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Due to inconsistent information obtained through interviews, LPA was unable to determine if a violation occurred.

Based on the investigation conducted, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation of a staff member inappropriately handling day care children occurred. As a result, the allegation is UNSUBSTANTIATED.

An exit interview was conducted and Notice of Site Visit was provided to be posted for 30 days.
Facility evaluation report was emailed to Director and an email verification of receipt of report will be used in lieu of a signature on this report.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 03-CC-20210119145152
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
FACILITY NUMBER: 343615181
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

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Director stated that they will conduct staff training meetings on stress and conflict management as well as increase communication strategies to strengthen interpersonal relationships amongst the staff.
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This requirement was not met as evidenced by: interviews revealed that a staff member used inappropriate language in front of day care children towards another staff member during a confrontation. This is an immediate risk to the health and safety of the children in care.
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To correct the deficiency, Director shall submit to Licensing a copy of the staff meeting minutes and a copy of the sign in sheet showing which staff were trained.
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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5