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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313624657
Report Date: 10/08/2024
Date Signed: 10/08/2024 04:21:02 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
10/04/2024 and conducted by Evaluator Katrina Owens
COMPLAINT CONTROL NUMBER: 03-CC-20241004152811
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
313624657
ADMINISTRATOR:HOLIGA, SAMANTHAFACILITY TYPE:
850
ADDRESS:2081 OAK MEADOW DRIVETELEPHONE:
(916) 945-2203
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:144CENSUS: 79DATE:
10/08/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Samantha Holiga - DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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RATIO- Facility operating out of ratio
LACK OF SUPERVISION: Facility staff did not provide adequate supervision resulting in children eloping.
INVESTIGATION FINDINGS:
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An unannounced inspection was conducted by Licensing Program Analyst Owens and McClain. LPA's met with Owner, Dipna Desai and Director, Samantha Holiga. Present at time of inspection were 51 preschool children with 7 staff and 28 children in toddler option with 6 staff. The purpose of the inspection is to open and close a complaint investigation. Interviews and tour of the multi-purpose room conducted.

Based on interviews and video footage on 10/3/2024 12 children and 3 staff were in the multi-purpose room. A staff was standing by the door with two children that leads outside to the grass/playground area. When staff walked away from the door to attend to other children, the two children by the door pushed the door bar, opening the door, and went outside. When the teacher turned around and saw the children on the grass area she immediately ran to the door to get the children. The LPA's reviewed the video footage that showed the incident; the timing on the video showed approximately 14 seconds lapsed time from the teacher turning her back until the time the teacher retrieved the children. No injuries to children occurred and the area the children entered was fully gated on all sides.

Based on interviews and video footage an incident happened when a teacher left the classroom leaving one staff with 19 children. The video footage shows the teacher leaving the classroom entering and standing in the hallway of the facility, the teacher was immediately called back to the classroom to put classroom back into ratio.

The preponderance of evidence standard has been met during this investigation, therefore the above allegations are found to be SUBSTANTIATED. Violations of the California Code of Regulations, Title 22, Division 12 & Chapter 3 are being cited on the attached.
Notice of cite visit posted Appeal rights given and explained at time of inspection.



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Brekke
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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-20241004152811
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: 313624657
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
101216.3(a)
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TEACHER CHILD RATIO:
There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.
This requirement was not met by
on one occasion one teacher was left
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Director stated that a teacher now stands at the door in the multi purpose room at all times. The facility gave the LPA at time of inspection their written plan of action for the multi purpose room.

Deficiency cleared at time of inspection.
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supervising 19 children. A teacher was called back to the classroom immediately to be back in ratio. This is a potential risk to a child.
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Type B
11/08/2024
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The Owner stated their plan of action was the staff that left the classroom was terminated.

Deficiency cleared.
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This requirement was not met by.
two children got out of the multi purpose room on to the play/grass area that was completely gated with no supervision for approximately 14 seconds based on video footage. This is a potential risk to a child.
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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: Jennifer Brekke
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2