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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343615181
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:43:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 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
02/24/2023 and conducted by Evaluator Jennifer Velasco
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230224153747
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: 84DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:William Pu, Katelynn Lee, Selena RovaneTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not ensure that a separate, complete and current record for child was maintained in the facility.
Staff did not isolate child who became ill while in care.
Staff did not report a change in condition of child in care to their authorized representative.
Staff did not store food for child in a safe manner.
INVESTIGATION FINDINGS:
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Licensing Program Manager Natalie Dunaway (LPM) and Licensing Program Analysts Erwina Pascual-Golamco and Jennifer Velasco (LPA) conducted unannounced subsequent complaint investigation inspection and met with Administrator William "Bill" Pu, Director Katelynn Lee (D1), and Director Selena Rovane (D2). LPAs toured the facility, including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included 84 preschool children being supervised by 12 classroom staff. D1 was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

The following violations were alleged: Staff did not ensure that a separate, complete, and current record for child was maintained in the facility. Witness statements and review of facility records provided corroboration the facility did not ensure a complete and current record for a child (C1). It was also alleged staff did not isolate child who became ill while in care and that staff did not report a change in condition of child in care to their authorized representative.
Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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-20230224153747
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 343615181
VISIT DATE: 05/04/2023
NARRATIVE
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 Continued from LIC 9099

Witness statements and document reviews provided corroboration that staff did not isolate an ill child (C1) and did not report the child’s illness to the authorized representative in a timely manner.

It was further alleged staff did not store food for child in a safe manner. LPA observation and witness statements corroborated this allegation, as the facility engaged in the practice of removing and instructing parents to remove perishable food from children’s insulated lunchboxes, often equipped with ice packs/cold packs, and putting the perishable food into a plastic bin, unrefrigerated, for as long as a few to several hours between morning drop-off and lunchtime.

During the investigation, LPA conducted interviews, observed staff provide care to children, and obtained relevant and reviewed documentation. Witness statements, observations, and document reviews corroborated the allegations that staff did not ensure a complete record for a child, did not isolate an ill child, did not report a change in a child's condition to the authorized representative, did not store children's food in a safe manner, and did not administer non-prescription medication to a child as necessary.

A Type A violation was issued today. The center is informed to provide a copy of this Evaluation Report and the Type A Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all children's files. This report and appeal rights were provided and reviewed with the licensee. Notice of Site Visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 03-CC-20230224153747
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 343615181
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2023
Section Cited
CCR
101226.3(a)
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Observation of the Child (a) The behavior and health of the children shall be continually observed throughout the period of attendance. This requirement was not met as indicated by: witness statements and LPA review of facility
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Director (D1) stated staff have been trained to monitor children's health condition upon arrival and throughout the day, and thermometers have been put in each classroom so teachers can check temperatures as indicate D1 stated she will
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records indicate staff failed to observe a child (C1) had developed a fever and suffered a medical emergency until another child advised staff of this. This posed an immediate risk to the health and safety of children in care.
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develop a detailed written plan and will email to LPA by close of business POC due date.
jennifer.velasco@dss.ca.gov
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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: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 03-CC-20230224153747
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 343615181
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2023
Section Cited
CCR
101221(a)
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Child's Records (a) A separate, complete, and current record for each child is maintained in the child care center. This requirement was not met as indicated by: witness statement and LPA document reviews showed staff failed to ensure a current and complete care plan
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Director stated the staff will check children's files in an internal audit process to ensure all children's records are complete. Director stated she will provide by email by close of POC due date a detailed written plan for ensuring all children's records are complete.
jennifer.velasco@dssca.gov
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was on file at the facility. This posed a potential risk to the health and safety of children in care.
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Type B
05/05/2023
Section Cited
CCR
101226.2(b)
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 Isolation for Illness (b) The child's authorized representative shall be notified immediately when the child becomes ill enough to require isolation and shall be asked to have the child removed from the center as soon as possible. This requirement was not met as indicated by:
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Director stated the facility has revamped its isolation practices such that any ill child is isolated immediately and the parent is contacted immediately. Director stated she will write a detailed written plan that provides these specifics by email by close of POC due date. jennifer.velasco@dss.ca.go
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LPA document reviews and witness statements that staff failed to notice and report to the authorized representative of a child (C1) in a timely manner that C1 was ill. This posed a potential risk to the health and safety of children in care.
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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: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 03-CC-20230224153747
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 343615181
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2023
Section Cited
CCR
101227(a)(15)
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Food Services (a) (15) All foods or beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C)
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Director stated based on technical assistance provided by LPAs during initial visit the staff has changed its practices to ensure all perishable food is kept at the required safe temperature. Director stated she will provide detailed written plan documenting this updated practice via email.
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or less. This requirement was not met as indicated by: LPA observation and witness statements that staff kept perishable food unrefrigerated for a few to several hours. This posed a potential risk to the health and safety of children in care.
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jennifer.velasco@dss.ca.gov
CCR
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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: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5