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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371676
Report Date: 06/10/2024
Date Signed: 06/10/2024 09:46:21 AM

Document Has Been Signed on 06/10/2024 09:46 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
304371676
ADMINISTRATOR/
DIRECTOR:		PATEL, P. & MEHTA, P.FACILITY TYPE:
860
ADDRESS:1629 VICTORY ROADTELEPHONE:
(714) 439-9450
CITY:TUSTINSTATE: CAZIP CODE:
92782
CAPACITY: 228TOTAL ENROLLED CHILDREN: 228CENSUS: 0DATE:
06/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:P. Patel, Applicant and C Roe, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) P Rivas conducted a case management visit to obtain further corrections and to correct information on licensing report of 05/31/24
The following was provided for corrections requested 06/07/24;
1. Lic 200a #10 was total number was identified..
2. Corrected Lic 401 that adjusted rental amount to coincide with lease agreement.
3.Std850 dated 06/07/24 but signed on 05/28/24 indicated Occupancy E with Special Condition;
REVIEWED AS E OCCUPANCY BEFORE E/I-4 OCCUPANCY CODE CHANGES. MEETS I-4 CURRENT REQUIREMENTS BUT WAS REVIEWED AS AN"E".
4. LPA received lic 9108, declination of flu vaccine , immunizations for Ms. Roe
5. An addendum was received to Personnel Policies; Provided employee rights,
6. An Addendum was received to Personnel Policies. ; including lines of supervision, minimum qualifications for; infant teacher, pre school teacher, admin staff and floater..
7. Updated training included recognition of early signs of illness and the need for professional assistance Section 3.10 Training in Employee Handbook.
8. Child Care Program Description was updated on pages 7, 20, 26 to show operating hours as 7:00am-6:00pm.
9. Child Care Program Description -Addendum to include the Infant Sleep requirements.
10. Child Care Program Description -Addendum included requirement to obtain lic 995, Notification of Parents Rights, Lic 613a Personal Rights, Lic 700 Identification & Emergency Information, Lic 627 Consent for Emergency Information, lic 702 Child's pre admission Health History-Parents Report, Immunization requirements.
11. Schedule of Daily Activities for infants -Includes statement" Custodial care, such as diapering, meals and napping is addressed as needed by the child's individual routine throughout the day.
12. Admission agreement Updated to correct hours to 7:00am to 6:00pm.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 304371676
VISIT DATE: 06/10/2024
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13.Ms. Preeti Patel provided copy of immunization's including TB Mandated Reporter Training Certificate, Application Orientation Certificate, Child Care Center Record Keeping, Mandated Reporter Training Certificate , Statement Acknowledging Requirement to Report Child Abuse.
14. Licensing report dated 05/31/24 incorrectly provided the inside square footage. All other information on report was correct. Corrected Square Footage is 8059.23, which is sufficient to accommodate the requested capacity.


Based on today's visit and review of further documents. The facility can be licensed effective 06/10/24.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
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