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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846439
Report Date: 10/02/2023
Date Signed: 10/02/2023 04:13:31 PM

Document Has Been Signed on 10/02/2023 04:13 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
334846439
ADMINISTRATOR:KING,DIANNEFACILITY TYPE:
830
ADDRESS:18177 VAN BUREN BLVDTELEPHONE:
(951) 542-2900
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 29TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Director Dianne King and Applicant Ali M. ZafarTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to follow up on the initial Prelicensing inspection conducted on 8/29/2023. At the conclusion of that inspection, a list of items that needed completion was provided. Also, LPA Lopez was informed that room 123 (Infant B) was reconfigured and now included a napping area, therefore not requiring a waiver. During today's inspection, LPA toured the facility, remeasured room 123 (Infant B), and verified that the facility has corrected all items required for licensure.

Room 123 (Infant B) was remeasured and the following was determined:
Infant Indoor Activity Areas - rooms 122 (A) and 123 (B):
LPA has determined that there is sufficient indoor activity space to accommodate the capacity of 31 infants.

Limiting factor for infant capacity is the Fire Clearance granted.
Infant capacity is limited to 24 children.

The application will be submitted for approval with a maximum capacity of 24 infants.

Exit interview conducted and report was reviewed with the Director Dianne King and Applicant Ali M. Zafar.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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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