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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600689
Report Date: 08/05/2024
Date Signed: 08/05/2024 07:05:06 PM


Document Has Been Signed on 08/05/2024 07:05 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 RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:STRATFORD, THEFACILITY NUMBER:
415600689
ADMINISTRATOR:CAMILLE CHRISTIEFACILITY TYPE:
741
ADDRESS:601 LAUREL AVETELEPHONE:
(650) 342-4106
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:96CENSUS: 78DATE:
08/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lori Wolfe and Janie WooTIME COMPLETED:
07:00 PM
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LPA Audrey Jeung toured facility and grounds of this Continuing Care Retirement Community, consisting of studio, one, two and three bedroom apartments--each with full private bathrooms--on 10 floors. On the 2nd floor, there are 9 studio apartments which comprise the Laurel Wing, where up to 12 residents can receive assisted living services; there are 5 residents in the Laurel Wing with 2 caregivers and an LVN present. Facility provides 3 meals daily to those residents of the Laurel Wing. Dinner meal is provided to other residents, who are mostly independent. Food supplies of perishables for 2 days and non-perishables for 7 days are maintained. Common areas on the ground floor include living room, library, fitness room, sauna room, indoor pool, dining room. On the 11th floor, there is a large and small meeting room. No fire safety hazards are observed. PPE supply is adequate and first-aid kit is inspected and complete. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Centrally Stored Medications Records are maintained. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. Emergency call system is installed in all rooms; when cord is pulled, staff with cell phones are alerted, and a visual and audio alert appears on monitors at Laurel Wing nurses station and reception desk on ground level. An updated Disaster and Mass Casualty Plan is accessible. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Executive director Janie Woo is an RCFE administrator and is assisted by resident care director/RN Lori Wolfe, who is a certified RCFE administrator (x 5/26). Staff and client records to be reviewed at a later date.

The following updated forms/information are requested to be submitted to CCLD BY 8/19/24:
• LIC 308 Designation of Administrative Responsibility
• Bedridden Plan of Operation
• Medication Training requirements for staff

LPA is provided with the following information today:
• LIC 500 Personnel Reports
• LIC 610 Emergency Disaster Plan

No deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2024
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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