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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423042
Report Date: 11/06/2024
Date Signed: 11/06/2024 01:31:56 PM

Document Has Been Signed on 11/06/2024 01:31 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:STRATFORD SCHOOL-FREMONT OSGOODFACILITY NUMBER:
013423042
ADMINISTRATOR/
DIRECTOR:		LIANAWATI, EKAFACILITY TYPE:
850
ADDRESS:43077 OSGOOD RDTELEPHONE:
(510) 438-9745
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 99TOTAL ENROLLED CHILDREN: 99CENSUS: 45DATE:
11/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Eka LianawatiTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On 11/06/2024, Licensing Program Analyst (LPA) Melanie Otsuji conducted an unannounced Case Management Visit - Incident inspection. LPA met with Director, Eka Lianawati, and explained the nature of the visit. Also present during this visit were 4 additional staff members and 45 preschool aged children. A health and safety inspection was conducted.

On 10/10/2024, the Director reported an Unusual Incident to the Regional Office (RO). The summary of the unusual incident is as follows: On 10/09/2024 - C1 was left unattended on the playground for a few minutes.

Based on the information received, a TYPE A deficiency is being cited on today's date, 11/06/2024 (see attached LIC809D).

LPA Otsuji informed facility representative, Eka Lianawati, that this report dated 11/06/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Otsuji informed the facility representative to provide a copy of this licensing report dated 11/06/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the Director, Eka Lianawati.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 11/06/2024 01:31 PM - It Cannot Be Edited


Created By: Melanie Otsuji On 11/06/2024 at 11:51 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: STRATFORD SCHOOL-FREMONT OSGOOD
FACILITY NUMBER: 013423042

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(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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Facility has already provided an emergency safety training with all staff. Plan was provided to LPA. This deficiency was cleared during the inspection.
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This requirement is not being met as evidence by: 1 child on one occassion was without visual supervision for a short duration of time. This poses an immediate risk to the health, safety, or personal rights to persons 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:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024


LIC809 (FAS) - (06/04)
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