343620246-9-4-2024-03-CC-NDUY-D8UU84-20240906152056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343620246
Report Date: 09/04/2024
Date Signed: 09/04/2024 10:29:04 AM

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
07/09/2024 and conducted by Evaluator Jennifer Velasco

COMPLAINT CONTROL NUMBER: 03-CC-20240709094104

FACILITY NAME:	GODDARD SCHOOL, THE		FACILITY NUMBER:	343620246
ADMINISTRATOR:	KATHRYN DRAKE		FACILITY TYPE:	830
ADDRESS:	251 OUTCROPPING WAY		TELEPHONE:	(916) 936-0377
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	24	CENSUS: 13	DATE:	09/04/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kaylee Agaman, Ruthie Araujo		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Children's hygiene needs are not met
Children have access to potentially hazardous items

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Velasco met with Facility Representative, Kaylee Agaman and Ruthie Araujo (Representative), for the purpose of conducting an unannounced complaint investigation inspection pertaining to the above allegation. The purpose of today's inspection was explained to Representative. During today's inspection, LPA toured the facility, observed care, and presented findings. Based on LPA’s document review and multiple witness statements, a staff (Staff1) failed to meet an infant's hygiene needs in that Staff1 failed to change an infant's soiled clothing during a diaper change until ordered to do so by another staff. Staff1 also allowed infants to have access to gloves worn by staff during diaper changes. The infant did not sustain injury, but Staff1 placed the gloves in a place accessible to an infant until ordered by another staff to make the gloves inaccessible. The preponderance of evidence standard has been met; therefore, the above allegations are SUBSTANTIATED. Staff1 was terminated during LPA's initial 07/09/2024 complaint investigation inspection. The Facility Representative was informed that Title 22 deficiencies are being cited on LIC 9099-D. Exit interview was conducted and a copy of this report was given to the Facility Representative, Kaylee Agaman and Ruthie Araujo. Notice of site was given and must remain posted for parental review for 30 days. Appeal rights were provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 03-CC-20240709094104

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: 343620246
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/20/2024 Section Cited CCR 101428(b)	1 2 3 4 5 6 7	(b) The infant shall be kept clean and dry at all times. This requirement was not met as evidenced by: Multiple witness statements that a staff (Staff1) left an infant in soiled clothing after a diaper change until another staff ordered Staff1 to put clean clothes	1 2 3 4 5 6 7	Representative stated Staff1 was terminated during 07/09/2024 complaint investigation inspection. Representative stated all staff have received additional training regarding infants' hygiene needs and best practices. POC was cleared during this inspection.
	8 9 10 11 12 13 14	on the infant. This constitutes a potential health, safety, and/or personal rights risk to children in care.	8 9 10 11 12 13 14
Type B 09/20/2024 Section Cited CCR 101238(g)	1 2 3 4 5 6 7	(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by: Multiple witness statements that a staff	1 2 3 4 5 6 7	Representative stated Staff1 was terminated during 07/09/2024 complaint investigation inspection. Representative stated all staff have received additional training regarding the need to keep potentially hazardous items inaccessible to infants. POC was cleared during this inspection.
	8 9 10 11 12 13 14	(Staff1) left soiled gloves accessible to an infant until ordered by another staff to dispose of the gloves so they were inaccessible to infants. This constitutes a potential health, safety, and/or personal rights risk to children in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC9099 (FAS) - (06/04)

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