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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004165
Report Date: 10/05/2026
Date Signed: 10/05/2026 01:52:15 PM

Document Has Been Signed on 10/05/2026 01:52 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:STRATFORD SCHOOLFACILITY NUMBER:
384004165
ADMINISTRATOR/
DIRECTOR:		CHIN, NICKYFACILITY TYPE:
850
ADDRESS:2425 19TH AVENUETELEPHONE:
(415) 564-6250
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 174TOTAL ENROLLED CHILDREN: 174CENSUS: 45DATE:
10/05/2026
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Nicky Chin and Maria RodriguezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On October 5, 2026, Licensing Program Analyst (LPA) Van conducted an unannounced case management inspection regarding an Action Level Exceedance (ALE) for lead in the facility’s water. The LPA met with Director Nicky Chin and Area Manager Maria Rodriguez. The purpose of the inspection was explained. At the time of the inspection, 45 children were supervised by 12 staff members, including the director.

The LPA discussed Assembly Bill 2370, Chapter 676, Statutes of 2018, which requires lead testing at child care centers located in buildings constructed before January 1, 2010. Applicable facilities were required to test their water and post the results by January 1, 2023, with subsequent testing required every five years from the initial testing date.

The facility received its ALE report from the testing vendor on August 26, 2026. The report identified Fixture A, located on the third floor, with a lead level of 5.6 parts per billion (ppb), exceeding the 5.5 ppb threshold. The area was formerly used as a teachers’ lounge and is now used for storage.

As an interim corrective measure, the facility posted a “Do Not Use Sink” sign at the affected fixture. The facility plans to have building maintenance remove the faucet, cap it, and permanently cover the faucet opening.

The LPA obtained electronic copies of the External Water Sampler Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist (LIC 9276), and Facility Sketch (LIC 999).

See LIC 809D for the deficiency cited during the inspection on the following page.

The report was reviewed with and signed by Director Nicky Chin.

A Notice of Site Visit was provided to the director and must remain posted for 30 days.

Garfield Leung
Brendon Van
DATE: 10/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 10/05/2026 01:52 PM - It Cannot Be Edited


Created By: Brendon Van On 10/05/2026 at 01:25 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: STRATFORD SCHOOL
FACILITY NUMBER: 384004165

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2026
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b)(1) 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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The facility had already placed the water outlet that exceeded the ALE threshold out of service. The facility plans to remove the faucet, cap the water line, and permanently cover the faucet opening. Upon completion, the facility director will submit photographs of the completed work and a copy of the work order to the LPA for review and clearance of the deficiency.
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Based on the record review, the center did not comply with the above-cited section of the regulation. The results received from the certified water samplers showed that the facility exceeded 5.5 ppb of lead in its water source. This poses a potential health, safety, or personal rights risk 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.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Brendon Van
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2026


LIC809 (FAS) - (06/04)
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