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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410807
Report Date: 10/20/2022
Date Signed: 10/20/2022 01:54:47 PM

Document Has Been Signed on 10/20/2022 01:54 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:
434410807
ADMINISTRATOR:MONISHA PANDITFACILITY TYPE:
850
ADDRESS:890 POMEROY AVENUETELEPHONE:
(408) 244-4073
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 264TOTAL ENROLLED CHILDREN: 231CENSUS: 187DATE:
10/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Monisha PanditTIME COMPLETED:
02:14 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Monisha Pandit, and explained purpose of visit: to follow-up on water lead testing conducted for Stratford School. Upon arrival, LPA toured the facility and requested Site Director identify the faucet with Action Level Exceedance (value of 5.5 parts per billion or greater).

LPA obtained the following facility documents during todays visit: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), and Facility Sketch (LIC999) labeled with locations of water outlets. Documents for initial test on 7/1/2022 and retesting on 9/22/2022 were obtained today.

Water sample conducted on 7/1/2022 by Adviro indicated faucet "S" had Action Level Exceedance value of 92 parts per billion (ppb). The facility has remediated the faucet by fully replacing it and flushing the faucet for four (4) weeks. During the four (4) weeks of flushing, the faucet was made inaccessible to children. The Site Director states that classroom B4, where the faucet is located, has not been used by children since before the previous summer.

Faucet "S" was retested on 9/22/2022 by Adviro and labeled as faucet "A" for the retesting. Upon completion of second lead test, the faucet lead level was measured at 3 parts per billion, within the safe limits.

Exit interview conducted and report was reviewed with the Site Director, Monisha Pandit.

As a result of todays inspection, a deficiency was cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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 10/20/2022 01:54 PM - It Cannot Be Edited


Created By: Cortney Nelson On 10/20/2022 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: STRATFORD SCHOOL
FACILITY NUMBER: 434410807

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2022
Section Cited

101700.3(b)(1)

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101700.3 Lead Testing Written Directives (b)(1) a result with values of 5.5 parts per billion (ppb) or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidenced by:
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The facility replaced faucet "S", made it inacessible to children, and flushed the faucet for 4 weeks. Retesting of the faucet was completed by Adviro on 9/22/2022 and the lead level was measured at 3ppb, within safe limits for the facility.
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Lead water testing conducted at Stratford School produced Action Level Exceedance of 92.0 ppb for Faucet "S" which poses a potential risk to the health, safety, and personal rights of children in care.
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The POC has been corrected at the facility and the faucet is safe to be used by children.

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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


LIC809 (FAS) - (06/04)
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