343620246-7-9-2024-03-CC-NDUY-D8UU85-20240906152057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343620246
Report Date: 07/09/2024
Date Signed: 07/09/2024 04:36:23 PM

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
07/09/2024 and conducted by Evaluator Jennifer Velasco

COMPLAINT CONTROL NUMBER: 03-CC-20240709094104

FACILITY NAME:	GODDARD SCHOOL, THE		FACILITY NUMBER:	343620246
ADMINISTRATOR:	KATHRYN DRAKE		FACILITY TYPE:	830
ADDRESS:	251 OUTCROPPING WAY		TELEPHONE:	(916) 936-0377
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	24	CENSUS: 14	DATE:	07/09/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Kaylee Agaman		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff member handles daycare children in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Velasco met with Facility Representative, Kaylee Agaman (Representative), for the purpose of conducting an unannounced initial complaint investigation inspection pertaining to the above allegation. The purpose of today's inspection was explained to Representative.
During today's inspection, LPA toured the facility, conducted five staff interviews, observed care, and obtained relevant facility documentation. Based on LPA document review and multiple witness statements, a staff did handle infants in a rough manner by grabbing them or picking them up by one arm. The preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED. The Facility Representative was informed that this report dated 07/09/2024 documents one Type A citation and must be posted for parental review for 30 consecutive days. The facility must also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in each child's file for verification.
Exit interview was conducted and a copy of this report was given to the Facility Representative, Kaylee Agaman. Notice of site was given and must remain posted for parental review for 30 days. Appeal rights were provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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-20240709094104

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: 343620246
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/09/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/10/2024 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	Personal Rights.(a)The licensee shall ensure that each child is accorded the following personal rights: (1)To be accorded dignity in his/her personal relationships with staff and other persons .... This requirement was not met as evidenced by witness statements	1 2 3 4 5 6 7	Representative stated the staff will be terminated immediately and that they will develop a detailed written plan for ensuring this does not occur again. They stated they will email the written plan to LPA by close of business POC due date: jennifer.velasco@dss.ca.gov
	8 9 10 11 12 13 14	and document review, which corroborated the allegations of a staff handling children roughly by grabbing them and picking them up by their arm. This constitutes an immediate health, safety, and/or personal rights risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC9099 (FAS) - (06/04)

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