343624789-5-4-2023-03-CC-EPGO-CRHTU9-20230504150157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624789
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:02:05 PM

Document Has Been Signed on 05/04/2023 03:02 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	GODDARD SCHOOL, THE		FACILITY NUMBER:	343624789
ADMINISTRATOR:	PU, WILLIAM		FACILITY TYPE:	830
ADDRESS:	3370 ZINFANDEL DRIVE		TELEPHONE:	(916) 861-0906
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	05/04/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	William Pu		TIME COMPLETED:	03:30 PM

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Licensing Program Manager Natalie Dunaway and Licensing Program Analysts (LPA) Erwina Pascual-Golamco and Jennifer Velasco met with Applicant William Pu for the purpose of an announced pre-licensing change of location inspection. Applicant requests an infant license to serve 24 infants from zero to 24 months in age, with 12 infants under 12 months old due to available cribs. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 5/3/23.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, snack menus, and daily schedule.

All infant food and supplies will be brought from home.

INDOOR ACTIVITY SPACE:
There are two infant classrooms: LPA observed a sufficient number of tables, chairs, cubbies, and napping cots for 24 infants.

Report continues on 809-C.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GODDARD SCHOOL, THE	FACILITY NUMBER: 343624789
	VISIT DATE: 05/04/2023

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LPA measured two classrooms. The total classroom space contains a total of 965.88 square feet, which accommodates Applicant's request for 24 infants. There are two changing tables within arm's reach of a sink and two additional sinks in each classroom. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property for infants. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall and separates the preschool yard from the infant yard. LPA observed outdoor equipment. LPA observed foam mat beneath the structure to ensure cushioning material to absorb any falls. There are no bodies of water on the premises. Shade is provided by a covered patio and canopy over the play structure.

LPA measured the outdoor activity space. The outdoor play area contains a total of 3618.08 square feet, which accommodates the requested capacity of 24 infants. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

LPA discussed the following: 100% supervision is required at all times, personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on 809-C.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GODDARD SCHOOL, THE	FACILITY NUMBER: 343624789
	VISIT DATE: 05/04/2023

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed with licensee the safe sleep regulations and Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The following items are required before a license will be issued:

1. Licensing Program Manager’s final file review.

2. A waiver must be requested and approved for shared use of the covered patio with the Preschool Program.

3. A return visit/email documentation must be made to observe (classroom) materials and equipment, first aid kit, cribs, and storage of cleaning supplies and medication.

4. A new fire clearance showing classroom 2 to be placed on the infant license.

Exit interview conducted and report was reviewed with the licensee William Pu.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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