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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313624657
Report Date: 03/14/2023
Date Signed: 03/14/2023 11:39:20 AM

Document Has Been Signed on 03/14/2023 11:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
313624657
ADMINISTRATOR:NAIK, SHARMILIFACILITY TYPE:
850
ADDRESS:2081 OAK MEADOW DRIVETELEPHONE:
(916) 945-2203
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 40DATE:
03/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Samantha HoligaeTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Jeremey McClain and Soleil Marx conducted a case management inspection with Licensing Representative Samantha Holiga for the purpose of a Collateral Visit.

LPAs conducted a staff interview for a complaint investigation that is not related to this facility.

This report was reviewed with the licensing representative. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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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