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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343620245
Report Date: 12/04/2023
Date Signed: 12/15/2023 10:25:45 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2023 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20231201153332
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
343620245
ADMINISTRATOR:KATHRYN DRAKEFACILITY TYPE:
850
ADDRESS:251 OUTCROPPING WAYTELEPHONE:
(916) 936-0377
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:132CENSUS: 87DATE:
12/04/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kaylee AgamanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff left daycare child unattended
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erwina Pascual-Golamco and LPA Jennifer Velasco met with Licensee Kaylee Agaman (Licensee) to deliver findings. LPAs toured the facility, including all activity and classroom spaces, restrooms, food service and outdoor play areas. Director 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.
It was alleged staff left a daycare child unattended. During the investigation, LPA conducted interviews, observed care, and obtained relevant and reviewed documentation. Some details. Witness statements and media/documentation reviews corroborated the allegation that on 11/01/2023, a child (Child1) was left unattended on the facility playground for two minutes until a non-staff adult observed Child1 alone on the playground and notified facility staff, who retrieved Child1 and notified Child's parent(s). This incident was also self-reported to the Department by facility staff. The preponderance of evidence standard has been met, and the allegation is substantiated.
A Type A violation was issued today. D1 was instructed to provide a copy of this Evaluation Report and the continuation page LIC 9099-D, on which the deficienc is cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children for the next 12 months. A signed and dated LIC 9224 shall be maintained in each child’s file. This report and appeal rights were provided and reviewed with Licensee Kaylee Agaman. This report and the notice of site visit must remain posted for parental review for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
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 2
Control Number 03-CC-20231201153332
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 343620245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2023
Section Cited
CCR
101229(a)(1)
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The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time ... Supervision shall include visual observation. This requirement is not met as evidenced by:
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Licensee stated the two responsible staff were terminated, parents and staff were immediately notified, and remaining staff will receive additional training on supervision during transitions.
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 Facility self reported that on 11/01/2023, during afternoon transition from outside to inside, Child1 was left unattended on the playground for approximately two minutes. This is an immediate health and safety risk to children in care.
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Licensee stated they will email by close of business POC due date both the training materials and the staff sign-in sheet.
LPA email: 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.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC9099 (FAS) - (06/04)
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