<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408900
Report Date:
12/14/2022
Date Signed:
12/14/2022 09:52:48 AM
Document Has Been Signed on
12/14/2022 09:52 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, THE
FACILITY NUMBER:
073408900
ADMINISTRATOR:
KATHERINE ESPANOL RIVAS
FACILITY TYPE:
850
ADDRESS:
115 TECHNOLOGY WAY
TELEPHONE:
(925) 390-3313
CITY:
BRENTWOOD
STATE:
CA
ZIP CODE:
94513
CAPACITY:
144
TOTAL ENROLLED CHILDREN:
99
CENSUS:
67
DATE:
12/14/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:15 AM
MET WITH:
Katherine Rivas and Geetha Venkataganesh
TIME COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management visit. LPA met with owner Geetha Venkataganesh and Director Katherine Rivas.
The purpose of today's visit is to amend report LIC9099-D form visit on 12/8/22. The director's signature was not obtained on the report during the visit on 12/8/22. Report is amended to obtain signature of director only. There were no other changes to the report.
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:
12/14/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/14/2022
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
1