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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620245
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:55:27 PM

Document Has Been Signed on 01/08/2025 03:55 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
343620245
ADMINISTRATOR/
DIRECTOR:		KATHRYN DRAKEFACILITY TYPE:
850
ADDRESS:251 OUTCROPPING WAYTELEPHONE:
(916) 936-0377
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 132TOTAL ENROLLED CHILDREN: 132CENSUS: 75DATE:
01/08/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Kaylee AgamanTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Erwina Pascual-Golamco and LPA Jennifer Velasco met with Facility Representative, facility owner Kaylee Agaman (Representative), for an unannounced case management inspection to follow up on an unusual incident. Representative was notified of the reason for the inspection.

On 01/07/2025, Sacramento Regional Office received an Unusual incident Report (UIR) in which the facility self-reported an allegation of a personal rights violation on 01/06/2025. During today's inspection, LPAs observed staff provide care to children, reviewed facility documentation, and conducted interviews with children and staff. Based on information gathered during today’s inspection, no deficiencies were cited.

This report was reviewed with facility owner Kaylee Agaman, and an exit interview was conducted. A Notice of Site Visit (NOS) was provided and must remain posted for a period of 30 days for parental review.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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