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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408900
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:38:35 AM

Document Has Been Signed on 12/08/2022 11:38 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:
073408900
ADMINISTRATOR:KATHERINE ESPANOL RIVASFACILITY TYPE:
850
ADDRESS:115 TECHNOLOGY WAYTELEPHONE:
(925) 390-3313
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 144TOTAL ENROLLED CHILDREN: 99CENSUS: 57DATE:
12/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Katherine Rivas and Geetha VenkatagaTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management visit. LPA met with owner Geetha Venkataganesh and Director Katherine Rivas in response to a self reported incident.

On 11/29/22 a child was left on the outside play yard unsupervised. The incident occurred when children were transitioning to the classroom from outdoor play. The children transitioned to the classroom and teachers did not notice that a child was left outside. Director saw the child on the play yard without supervision and took the child to the classroom. Owner stated that the video footage showed that the child was left without supervision for 2 minutes.

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.

This is a zero tolerance violation. An immediate $500 is assessed today and $100 per day will be assessed until corrected. Subsequent zero tolerance violations are $1000 immediate civil penalty and $100 per day will be assessed until corrected.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview conducted and report reviewed with Katherine Rivas and Geetha Venkataganesh
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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 12/14/2022 09:50 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/13/2022 05:56 PM


Created By: Cherie Acosta On 12/08/2022 at 10:42 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
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: 12/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/09/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any
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-Citation is cleared during visit

Staff received training 12/7/22. The facility has implemented a new name to face procedure.
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time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: A child was left outside unsupervised which poses an immediate risk to the health and safety of children 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.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
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