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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408877
Report Date: 10/19/2022
Date Signed: 10/19/2022 09:54:54 AM


Document Has Been Signed on 10/19/2022 09:54 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:STRATFORD SCHOOLFACILITY NUMBER:
434408877
ADMINISTRATOR:SWATHI KRISHNANFACILITY TYPE:
850
ADDRESS:400 NORTH WINCHESTER BOULEVARDTELEPHONE:
(408) 244-2121
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:91CENSUS: 64DATE:
10/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Swathi KrishnanTIME COMPLETED:
10:40 AM
NARRATIVE
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 Licensing Program Analyst (LPA) Kaur conducted an unannounced Case Management inspection. LPA met with Director Swathi Krishnan and explained the reason for the inspection.The purpose of this inspection is lead testing completed with an exceedance. The facility had a result of 7.80,7.60.7.40ppb. LPA reviewed the water sample summary and asked director to identify faucet "A,B and D" with reported Lead Action Level Exceedance.

LPA was accompanied by Director to check Rooms 103,104 and 107. LPA observed that the classroom faucet is labelled. All faucets indicated that they are only using faucet to wash their hands. LPA observed filtered water container in the classroom. Director stated that they use britta filtered water.

LPA obtained a copy of the LIC 9275, LIC 9276, and facility sketch which indicates the location of all water outlets during today's inspection.

Facility had fixed the faucets pipe on 08/23/22 with Ecco Services. Director stated that they had retested again and waiting for results to come out.
As a result of this inspection, Type B deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Director Swathi Krishnan.



A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022
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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Document Has Been Signed on 10/19/2022 09:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: STRATFORD SCHOOL
FACILITY NUMBER: 434408877

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/31/2022
Section Cited

101700.3(b)(1)

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Lead Testing Written Directives - 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 faucets have "Do Not Drink" sign was placed. Faucets are use for hand washing only. The children are using filtered water for drinking purposes.

The facility to submit a new water
sample test result to Licensing that is within the reporting limits by 10/31/22.
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The Lead Sampling Report in three identified faucest are 7.40,7.60,7.80 ppb. This poses a potential risk to the health, safety, or personal rights of children 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.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (408) 529-3696
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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