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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407977
Report Date: 11/19/2019
Date Signed: 11/19/2019 12:27:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:STRATFORD SCHOOLFACILITY NUMBER:
434407977
ADMINISTRATOR:ANGELA MANOSCAFACILITY TYPE:
850
ADDRESS:6670 SAN ANSELMO WAYTELEPHONE:
(408) 363-2130
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY:192CENSUS: DATE:
11/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Manosca, AngelaTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz, Araceli met with Director Manosca, Angela. The purpose of this visit was to discuss violations that took place on 10/25/2019.. The case management inspection was initiated by a self reported unusual incident that was reported on 10/28/2019 and the written report was faxed to our office on 11/05/2019. A child was left unsupervised and found in the lavatory in a classroom.

The following issues were discussed during today's visit:
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Based on self report and interviews with staff it has been determined civil penalties in the amount of $500.00 will be assessed on todays date and a Type A deficiency will be cited for supervision violation 101229(a)(1). There is an additional Type B violation 101212(d) for failing to submit a faxed report of the incident within 7 days. The deficiencies are listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.

Training on supervision, has been provided to all staff on 10/30/2019. Director Manosca submitted proof of staff attendance for 10/30/2019. The Director states additional training with staff will be ongoing to ensure supervision. Director Manosca will convey the severity of lack of supervision discussed during today's visit with staff. The Director will review today's report with the staff, and have all staff, including Director sign a statement that this regulation is understood.. The Director will notify CCL upon completion of the task no later than 11/20/2019, close of business..

Upon receipt of this report, director shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

*****Page 1/2, Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STRATFORD SCHOOL
FACILITY NUMBER: 434407977
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2019
Section Cited

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Responsibility for Providing Care and Supervision : (a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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This requirement was not met as evidenced by child #1 was left unattended in a classroom/lavatory. This is based on a self reprot made by facility and interviews conducted with staff.
This poses an immediate risk to the heelth and wsafety of the children in care.
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The Director will notify CCL upon completion of the task no later than 11/20/2019, close of business via email. Director is to submit proof of plan of additional supervision measures.

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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: STRATFORD SCHOOL
FACILITY NUMBER: 434407977
VISIT DATE: 11/19/2019
NARRATIVE
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 A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview, copy of report was given. Appeal rights were issued and discussed.

*****Page 2/2, Final page of report continued from page 1*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STRATFORD SCHOOL
FACILITY NUMBER: 434407977
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2019
Section Cited

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Reporting Requirements: (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall
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be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by Director Manosca submitted writted report on 11/05/2019 to licensing. This poses a potential risk to the health and safety of the children in are.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4