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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371162
Report Date: 04/13/2022
Date Signed: 04/13/2022 10:55:48 AM

Document Has Been Signed on 04/13/2022 10:55 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:STRATFORD SCHOOL - MISSION VIEJOFACILITY NUMBER:
304371162
ADMINISTRATOR:MOLENKAMP, CHERYLFACILITY TYPE:
850
ADDRESS:24741 CHRISANTA DR.TELEPHONE:
(949) 458-1776
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 46DATE:
04/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:P. L, deAvilla Head of SchoolTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Case Management Incident inspection, in response to an Unusual Incident Report submitted to the Licensing office on 4/6/22. LPA and the facility representative toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 46 preschool children with 4 preschool staff. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

An Unusual Incident Report UIR LIC624 form was submitted to the Licensing office on 4/6/22 detailing that a child #1 (see Confidential Names List LIC811) had injured their arm while playing on the outdoor play structure. It was later determined that the child #1 sustained a fracture in their wrist. The injury occurrence that led to the fracture was not witnessed by preschool staff. During today's inspection, LPA Valencia conducted a physical plant inspection of the facility, observed the classrooms/physical plants, took pictures of outdoor play structure, and interviewed staff and child #1 about the incident and supervision at the facility. It was determined from the information available to LPA during the inspection and investigation into the incident involving child #1 on 4/6/22, that there were approximately 22 to 23 children playing on the outdoor play area with 2 preschool staff (staff #2, and staff #3), and the child #1 had fallen off of a hanging bar about 3 feet, on to their right arm. The child went and hid under the structure then went to sit on the slide, where a staff #2 witnessed the child sulking and spoke with the child. Both staff #2 and Staff #3 were supervising children but child #1's injury and fall was not witnessed. Based on the information gathered by LPA it was determined that the facility had violated Title 22 Regulation section 101229(a)(1) related to Supervision. A printout of Title 22 Regulation Supervision was reviewed and provided to the facility representative during the inspection.
(continued on LIC809C)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: STRATFORD SCHOOL - MISSION VIEJO
FACILITY NUMBER: 304371162
VISIT DATE: 04/13/2022
NARRATIVE
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(page 2)
Based on LPAs observations and interviews the following violation is being cited in accordance with California Code of Regulations, Title 22 Section 101229(a)(1) , is/are being cited on the attached LIC 809D.

Due to the facility being cited a Type A violation, the licensee must post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/13/2022 10:55 AM - It Cannot Be Edited


Created By: Dean Valencia On 04/13/2022 at 09:57 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: STRATFORD SCHOOL - MISSION VIEJO

FACILITY NUMBER: 304371162

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/13/2022
Section Cited
CCR
101229(a)(1)

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101229(a)(1) SUPERVISION; 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.
This was not met as evidenced by:

Based on interview and record review by LPA
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The director of the preschool was not present at today's inspection, but will submit to LPA, via email, a detailed plan of supervision to proactively supervise the outdoor play area to help prevent and/or witness possible injuries and/or child falls. Director will email LPA an explaination for their response to this incident, and an explaination for possible
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it was determiend that a child #1 sustained an arm fracture as a result of a fall off of the outdoor play structure, and this fall was not witnessed by preschool staff. Facility self reported this incident in a timely fashion. This presents an immediate threat to child/ren's health and safety.
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supplementation of a third staff in a classroom of 22 to 24 children, to help ensure there is full supervision of all the children at all times, especially when playing outside on the play structure. Director will also submit to LPA the cushioning turf manufacturer directions/infomration to ensure that this cushioning surface is appropriate for the structure.

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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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Valencia
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2022


LIC809 (FAS) - (06/04)
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