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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621361
Report Date: 06/04/2024
Date Signed: 06/04/2024 12:30:33 PM

Document Has Been Signed on 06/04/2024 12:30 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GODDARD SCHOOL, THE (PS)FACILITY NUMBER:
313621361
ADMINISTRATOR/
DIRECTOR:		SHARMILI NAIKFACILITY TYPE:
850
ADDRESS:2021 WILDCAT BLVDTELEPHONE:
(916) 778-6620
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 132TOTAL ENROLLED CHILDREN: 132CENSUS: 118DATE:
06/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Mili NaikTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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Licensing Program Analyst (LPAs) Jeremey McClain and Kyrsten Williams met with facility representative Mili Naik for an unannounced Case Management Inspection regarding an Unusual Incident Report.

118 children supervised by 16 staff members were observed in separate rooms.

It was reported that on 05/22/2024, a child suffered a head injury that required stitches. It was stated that the child tripped over the foot the of another child on the playground during a race, causing them to hit their head on the cement. The child was treated immediately, and their parents were contacted. No other injuries were documented.

During today’s inspection, LPAs conducted interview with staff and observed the area where the injury occurred.

An exit interview was conducted with facility representative Mili Naik. No deficiencies were observed. A Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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