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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624789
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:53:42 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
05/20/2024 and conducted by Evaluator Erwina Pascual-Golamco
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240520135538
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
343624789
ADMINISTRATOR:PU, WILLIAMFACILITY TYPE:
830
ADDRESS:3370 ZINFANDEL DRIVETELEPHONE:
(916) 861-0906
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:24CENSUS: 21DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Katelynn LeeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff handles children in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) met with Director, Katelynn Lee, to deliver findings. Throughout the course of the investigation, LPA toured the facility, observed staff provide care to children, reviewed documentation, and conducted interviews. Interview and witness statements revealed that a staff have aggressively picked up and placed children down, has a negative tone and have talked negatively toward children. LPA interviews and witness statements corroborated the allegation that a staff handles children in a rough manner. The preponderance of evidence standard has been met, and the allegation is SUBSTANTIATED.

A Type A Title 22 Deficiency is issued on the attached LIC9099-D page. Director shall provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. Exit interview was conducted with Director, appeal rights were provided, and A notice of site visit was given to Director, who will post it where visible to parents/guardians for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224) must be placed in the child's file for verification.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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-20240520135538
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: 343624789
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2024
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the ff. personal rights: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule...or other actions of a punitive nature...this requirement was not met, as evidenced by:
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Director stated they will conduct training to all staff regarding the proper handling of children/personal rights and will follow up with a 30 day observation. Director will email agenda with date of training to LPM by 4PM POC due date and will email documentation of training including staff signatures and materials, no more than 2 days after scheduled training.
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Director did not comply with the section cited above as interviews, and witness statements reveal that a staff handles children in a rough manner, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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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: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2