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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407398
Report Date: 11/15/2022
Date Signed: 11/17/2022 11:27:40 PM

Document Has Been Signed on 11/17/2022 11:27 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
073407398
ADMINISTRATOR:INGRID ESCALANTEFACILITY TYPE:
850
ADDRESS:100 GATEKEEPER RDTELEPHONE:
(925) 560-9694
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 108TOTAL ENROLLED CHILDREN: 67CENSUS: 54DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Steven Nguyen & Anju KhemaniTIME COMPLETED:
03:37 PM
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On 11/15/2022 at 9:30am Licensing Program Analyst (LPA) Morgan Pringle met with Facility Staff member Steven Nguyen, for an Unannounced Annual Inspection. The facility Director was out during LPA’s inspection and the facility owner, Anju Khemani, arrived at 9:40am. During the inspection fifty-four (54) preschool age children and twelve (12) staff were present. Seven classrooms (Sparrows, Parrots, Peacocks, Falcons, Eagles, Owls and Robins) were toured for a health and safety inspection. The Parrots classroom is currently not in use. The facility operates from 7:30am – 5:30pm, Monday – Friday. The facility holds a license for infants, Facility #073407400 and school age, Facility #75700605 as well.

The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, medications, cleaning products, and hazardous materials were observed to be in inaccessible areas. The children’s bathrooms on site are clean, free from defects and in proper working order. All napping equipment is properly stored, clean and free from defects. All children have access to clean drinking water in and outside of the classrooms. The kitchen is clean well maintained and all hazards are in inaccessible areas. All children bring their lunch to school and the facility provides morning and afternoon snack. All food provided by the facility is properly stored and labeled. All medications are properly maintained, documented and stored at the facility. There are carbon monoxide and smoke detectors on site and a fully charged fire extinguisher on site. The outside play yard is fully fenced, clean, and free from hazards with plenty of shade. The play structure is sturdy and anchored into the ground. LPA did not observe any harmful or unattended bodies of water in or around the facility.



Continued on LIC809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 073407398
VISIT DATE: 11/15/2022
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The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible in the entry way of the facility. The fire/disaster drill log was is complete with the last drill logged on 10/10/2022. A physical census of the children and staff was taken and cross referenced with the sign-in and out log. All children were properly signed in and accounted for by their authorized representative. All staff have obtained a criminal record clearance. LPA obtained the facilities files, children’s files and staff files. All files were complete.

Owner was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Owner was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Owner that all forms can be downloaded at www.ccld.ca.gov. Owner was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage 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.

Continued on LIC809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC809 (FAS) - (06/04)
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