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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408899
Report Date: 05/18/2023
Date Signed: 05/18/2023 11:50:52 AM

Document Has Been Signed on 05/18/2023 11:50 AM - 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
073408899
ADMINISTRATOR:KATHERINE ESPANOL RIVASFACILITY TYPE:
830
ADDRESS:115 TECHNOLOGY WAYTELEPHONE:
(925) 390-3313
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 24TOTAL ENROLLED CHILDREN: 12CENSUS: DATE:
05/18/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Katherine Rivas and Geetha Venkataganesh..TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management visit. LPA met with Director Katherine Rivas and Licensee Geetha Venkataganesh.

Facility self reported an incident that occurred on 4/24/23. The director and a parent witnessed a teacher handling a child in a rough manner. There were no injuries to the child. The teacher was terminated on 4/24/23.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit interview and report reviewed with Katherine Rivas and Geetha Venkataganesh..
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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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Document Has Been Signed on 05/18/2023 11:50 AM - It Cannot Be Edited


Created By: Cherie Acosta On 05/18/2023 at 11:10 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 073408899

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/19/2023
Section Cited
CCR
101223(a)(3)

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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental
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The teacher that handled the child roughly has been terminated.
Director has provided training to staff on children's personal rights.
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abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by: teacher handled a child in a rough manner which is an immediate risk to the health and safety of children in care.

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*Repeat violations will result in a civil penalty of $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.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023


LIC809 (FAS) - (06/04)
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