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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620245
Report Date: 02/18/2022
Date Signed: 02/18/2022 01:21:27 PM


Document Has Been Signed on 02/18/2022 01:21 PM - It Cannot Be Edited

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, THEFACILITY NUMBER:
343620245
ADMINISTRATOR:FERGUSON, JAMIEFACILITY TYPE:
850
ADDRESS:251 OUTCROPPING WAYTELEPHONE:
(916) 936-0377
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:132CENSUS: 82DATE:
02/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jamie Ferguson and Kaylee AgamanTIME COMPLETED:
01:30 PM
NARRATIVE
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On Friday, February 18th, 2022, Licensing Program Analyst (LPA) Kelly Ferrara conducted a Case Management Inspection and met with Director Jamie Ferguson and Owner Kaylee Agaman. Today's census included 82 preschool children in care with 10 staff.

LPA Ferrara received an Unusual Incident Report from the facility regarding an incident that occurred on February 11th, 2022. During today's inspection to follow up on the incident, LPA interviewed Director, staff, and children. Interviews revealed that Staff #1 was standing behind Child #1 and had their arms held behind them, thereby restraining them. Staff #1 then told Child #2 to hit Child #1 and when the child did not initially respond, the staff repeated the request. It was stated in a written statement that the incident was out of frustration.

Director stated Staff #1 was immediately placed on leave while they conducted an investigation regarding the incident. Director stated that both children's parents were made aware of the situation.

Based on the information received, a Title 22 personal rights violation has occurred. See page 809-D for deficiency cited. Exit interview was conducted and a copy of this report was given to the Director. Notice of site was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/18/2022 01:21 PM - It Cannot Be Edited

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
FACILITY NUMBER: 343620245

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2022
Section Cited

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Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain…or other actions of a punitive nature… This requirement was not met as evidenced by: Staff #1 held Child #1's arms behind them, restraining them while telling Child #2 to hit Child #1.

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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: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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