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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410807
Report Date: 12/03/2021
Date Signed: 12/08/2021 08:53:58 AM

Document Has Been Signed on 12/08/2021 08:53 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:STRATFORD SCHOOLFACILITY NUMBER:
434410807
ADMINISTRATOR:NAMRATA VINEET BHALLAFACILITY TYPE:
850
ADDRESS:890 POMEROY AVENUETELEPHONE:
(408) 244-4073
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 264TOTAL ENROLLED CHILDREN: 264CENSUS: DATE:
12/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Namrata BhallaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Anna Morales conducted a CASE MANAGEMENT VISIT in regards to an incident that occurred on November 30, 2021. This incident was also reported to CDSS San Jose Regional Office on 12/1/2021.

The incident that occurred on 11/30/21 approximately at 3:25pm, while the children were playing in the playground during recess time. At the time of this incident there were 21 students and two teachers present. LPA interviewed the Director, Teacher and other parties involved. LPA toured the playgrounds and observed that there is enough resilient materials under the play structures.

EXIT INTERVIEW WAS CONDUCTED AND REPORT WAS REVIEWED WITH THE DIRECTOR. NO DEFICIENCIES WERE CITED.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAY
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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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