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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845953
Report Date: 04/14/2021
Date Signed: 04/14/2021 03:04:49 PM

Document Has Been Signed on 04/14/2021 03:04 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GODDARD SCHOOL, THEFACILITY NUMBER:
364845953
ADMINISTRATOR:NAN SONGFACILITY TYPE:
850
ADDRESS:16258 POMONA RINCON RDTELEPHONE:
(909) 247-5605
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 96TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Nan Song, Applicant
Lauren Coburn, Director		TIME COMPLETED:
11:28 AM
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On April 14, 2021 Licensing Program Analysts (LPAs) Elyse Jones and Kim Leung conducted a follow up Case Management for the purpose of taking measurements of the facility inside and outside. Upon arrival, LPAs met with Nan Song, Applicant and Lauren Coburn, Director. A facility tour was given inside and outside. Measurements of Room 4 (Little Earth), Room 5 (Little Mars), Room 6 (Little Jupiter), Room 7 (Pluto), Room 8 (Neptune), Room 9 (Uranus), Room 10 (Saturn), the preschool playground and the extra outdoor activity space between the two playgrounds were taken. LPAs observed age appropriate furniture, toys and materials in each room.

The carbon-monoxide detector in the downstairs kitchen was tested by the Applicant during this inspection and found to be functioning.

There is sufficient indoor activity space to accommodate a capacity of 129 preschoolers. There is sufficient outdoor activity space to accommodate a capacity of 121 preschoolers. Director submitted a waiver request to use the infant playground when infants are not using it. If the waiver is not granted the facility will be licensed for a capacity of 121 preschoolers. If the waiver is granted the facility will be licensed for a capacity of 129 preschoolers.

During the inspection LPAs reviewed Title 22 regulation section 101239 with the facility Director and Applicant. LPAs advised Applicant and Director that toys, furniture, equipment and supplies should be registered with the United States Consumer Product Safety Commission. Applicant and Director agreed to provide safe toys, furniture, equipment and supplies to the children in care.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2021
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GODDARD SCHOOL, THE
FACILITY NUMBER: 364845953
VISIT DATE: 04/14/2021
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An exit interview was conducted with the director. LPA provided the director with a copy of this report after the inspection. The Licensee agreed to acknowledge receipt of the email by replying, "I have received the LIC 809 dated April 14, 2021."

This report must be made available at the facility for 3 years for public review upon request.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
LIC809 (FAS) - (06/04)
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