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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407977
Report Date: 10/28/2022
Date Signed: 10/28/2022 12:29:20 PM


Document Has Been Signed on 10/28/2022 12:29 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, 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: 88DATE:
10/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:Angela ManoscaTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz, conducted an unannounced case management inspection and met with Angela Manosca, Director. LPA explained the purpose of today’s inspection is to follow-up lead testing completed on 7/1/22 that indicated a drinking fountain found to have Action Level Exceedance (ALE) of 6.0 ppb. Census was taken, LPA observed 88 children with total of 11 staff supervising. LPA reviewed the water sample summary and requested Director to identify drinking fountain “A” located in Room 1 with reported ALE of 6 ppb. LPA notes that on 10/11/22, water retesting was completed for drinking fountain “A” by water sampler vendor, Adviro, and retesting results came back passing at 1 ppb meeting California requirements. LPA observed that drinking fountain A is now being used for drinking and food preparation.

LPA obtained the following facility documents during todays inspection: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), Facility Sketch (LIC999) labeled with locations of water outlets that were tested and water retesting summary conducted by Adviro on 10/11/22.

As a result of this inspection, Type B deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Director, Angela Manosca.



A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
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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Document Has Been Signed on 10/28/2022 12:29 PM - It Cannot Be Edited

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: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited

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Lead Testing Written Directives - a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 

This requirement was not met as evidenced by:
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Based on record review, the Lead Sampling Report on 7/1/22 indicated that drinking fountain A in Room 1 had elevated lead above 5.5 ppb. This poses a potential risk to the health, safety, or personal rights of children in care.
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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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