343620245-5-18-2021-03-CC-MMAA-C37292-20210519171111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343620245
Report Date: 05/18/2021
Date Signed: 05/18/2021 01:14:01 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
02/23/2021 and conducted by Evaluator Kelly Ferrara

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210223150512

FACILITY NAME:	GODDARD SCHOOL, THE		FACILITY NUMBER:	343620245
ADMINISTRATOR:	FERGUSON, JAMIE		FACILITY TYPE:	850
ADDRESS:	251 OUTCROPPING WAY		TELEPHONE:	(916) 936-0377
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	132	CENSUS: 55	DATE:	05/18/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kaylee Agaman		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Lack of supervision resulted in one child inappropriately touching another child.
Licensee shared confidential information

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Ferrara met with Owner Kaylee Agaman in order to deliver findings for the above allegations. LPA verified that there are currently 55 children in care with six staff. During the investigation, LPA interviewed the Reporting Party, Owner, Director, two parents, and two staff.

It was alleged that a lack of supervision on the playground led to one child inappropriately touching another child. LPA reviewed video coverage of the alleged incident and observed that the children were playing together and both children pushed each other. It is unclear based on the video and statements made in interviews whether the physical touch was playful or intended to be inappropriate. LPA observed in the video that staff was standing on the playground facing the group of children when the incident occurred. Consistent statements were made during interviews that staff spoke to both children following the incident and advised them to keep their hands to themselves. Staff stated they have been trained on providing supervision to children in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

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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Control Number 03-CC-20210223150512

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: 343620245
	VISIT DATE: 05/18/2021

NARRATIVE

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t was alleged that the facility shared one parent’s contact information with another parent. Interviews revealed inconsistent statements regarding whether the information was shared with or without the other parent’s permission. LPA discussed Title 22 regulation 101221(c) regarding confidentiality of children’s records with the Owner and Director.

Based on the evidence obtained, LPA determined that the allegations are unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it. A copy of this report was given to the facility and a Notice of Site was provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

LIC9099 (FAS) - (06/04)

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