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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600689
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:59:52 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/27/2024 01:59 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: 81DATE:
08/27/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Janie WooTIME COMPLETED:
02:00 PM
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LPA Jeung reviewed random staff and client files to complete annual inspection of 8/5/24.

RCFE administrator certificate for executive director was submitted to CCLD, along with other requested information:
• LIC 308 Designation of Administrative Responsibility
• Bedridden Plan of Operation
• Medication Training requirements for staff
• Board Resolution appointing administrator Janie Woo

No deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed.
See also Technical Advisory Note.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024
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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