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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408900
Report Date: 11/30/2021
Date Signed: 11/30/2021 05:39:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2021 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20211122101009
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
073408900
ADMINISTRATOR:KATHERINE ESPANOL RIVASFACILITY TYPE:
850
ADDRESS:115 TECHNOLOGY WAYTELEPHONE:
(925) 390-3313
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:144CENSUS: 42DATE:
11/30/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Katherine RivasTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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The licensee did not comply with all terms and conditions set forth in the admission agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to investigate the above allegation.

During the investigation LPA reviewed documents and conducted interviews. It is determined that the facility did not follow the disciplinary procedures provided in the parent handbook. The facility failed to conduct a parent conference with parents of a child in care. The Parent Handbook indicates that this will be the first step in the disciplinary procedures.
Based on interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Notice of Site Visit was provided and must be posted for 30 days
Exit interview was conducted with Katherine Rivas
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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 02-CC-20211122101009
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 073408900
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/14/2021
Section Cited
CCR
101219(f)
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Admission Agreements The licensee shall comply with all terms and conditions set forth in the admission agreement. This requirement was not met as evidenced by: Facility did not follow disciplinary procedures
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The director shall submit a written plan of action describing how the facility will ensure to follow the disciplinary plan in the Parent Handbook
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in the parent handbook which poses a potential risk to children in care.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC9099 (FAS) - (06/04)
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