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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600689
Report Date: 08/05/2025
Date Signed: 11/26/2025 12:44:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2025 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250801130031
FACILITY NAME:STRATFORD, THEFACILITY NUMBER:
415600689
ADMINISTRATOR:JANIE WOOFACILITY TYPE:
741
ADDRESS:601 LAUREL AVETELEPHONE:
(650) 342-4106
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:96CENSUS: 74DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Janie WooTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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- Staff left resident in locked facility vehicle
INVESTIGATION FINDINGS:
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***********This report is amended 11/20/25************
LPA Jeung discussed incident of 7/22/25 with administrator. CCLD was notified of incident on 7/24/25 and a Report of Suspected Elder Abuse (SOC341) was submitted. An Unusual Incident Report was submitted to CCLD on 7/25/25 with an updated SOC341.
Information provided initially states that client and caregiver were left unattended in van for 5 minutes. The later SOC341 states that they were left in van unattended for 28 minutes. Another statement provided by facility reports that after caregiver contacted facility to report that they were trapped alone in the van, staff were sent to client's apartment. The written reports of incident from facility fail to explain how client and caregiver were locked in the van unattended: van driver exited the vehicle without communicating with his passengers. Client is confined to wheelchair, and complained that he had difficulty breathing.
LPA interviewed private caregiver of client #1, who was in the van with client on 7/22/25. Resident could not recall the incident.
Based on information reported by and obtained from facility staff and witnesses, this allegation is substantiated. The preponderance of evidence standard has been met. Deficiency of the California Code of Regulations, Title 22 is cited on a following page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 14-AS-20250801130031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: STRATFORD, THE
FACILITY NUMBER: 415600689
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2025
Section Cited
CCR
87464(f)(1)
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BASIC SERVICES
Basic services shall at a minimum include care and supervision as defined in Section 87101(c)(3) and HSC 1569.2(c).
This requirement was not met, as staff failed to supervise client #1 on 7/22/25, when facility driver exited van, leaving client and private caregiver inside with no
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All staff managers received training on operation of van doors and lift gate, facility drivers received training on transportation safety procedures, and driver #1 received a disciplinary action for negligence and resident abuse. Documentation is provided today.
Plan of correction is pending review.
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means to exit. In addition, when facility staff were notified that client was trapped inside the van, staff responded by going to client's apartment, instead of searching for the van. Licensee failed to ensure that client was supervised when staff left him in van for 28 minutes, which posed an immediate health, safety or personal rights risk to client 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.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
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