<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845954
Report Date: 04/14/2021
Date Signed: 04/14/2021 03:03:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
364845954
ADMINISTRATOR:NAN SONGFACILITY TYPE:
830
ADDRESS:16258 POMONA RINCON RDTELEPHONE:
(909) 247-5605
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:72CENSUS: 0DATE:
04/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Nan Song, Applicant
Lauren Coburn, Director
TIME COMPLETED:
11:28 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 14, 2021 Licensing Program Analysts (LPAs) Elyse Jones and Kim Leung conducted a follow up Case Management for the purpose of taking measurements of the facility inside and outside. Upon arrival, LPAs met with Nan Song, Applicant and Lauren Coburn, Director. A facility tour was given inside and outside. Measurements of Room 1 ( Little Sun), Room 2 (Little Mercury), Room 3 (Little Venus) and the infant playground were taken. LPAs observed age appropriate furniture, toys and materials in each room.

The carbon-monoxide detector in the downstairs kitchen was tested by the Applicant during this inspection and found to be functioning.

There is sufficient indoor activity space to accommodate the requested capacity. There is sufficient outdoor activity space to accommodate the requested capacity.

During the inspection LPAs reviewed Title 22 regulation section 101239 with the facility Director and Applicant. LPAs advised Applicant and Director that toys, furniture, equipment and supplies should be registered with the United States Consumer Product Safety Commission. Applicant and Director agreed to provide safe toys, furniture, equipment and supplies to the children in care.


An exit interview was conducted with the director. LPA provided the director with a copy of this report after the inspection. The Licensee agreed to acknowledge receipt of the email by replying, "I have received the LIC 809 dated April 14, 2021."

This report must be made available at the facility for 3 years for public review upon request.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1