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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410816
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:43:58 PM

Document Has Been Signed on 09/27/2023 04:43 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:STRATFORD SCHOOLFACILITY NUMBER:
434410816
ADMINISTRATOR:VIOLET SERYANIFACILITY TYPE:
850
ADDRESS:410 LLAGAS ROADTELEPHONE:
(408) 766-8801
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 17DATE:
09/27/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Violet SeryaniTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Annual Continuation inspection. LPA met with Principal Violet Seryani and explained the reason for the inspection. The purpose of this inspection is to continue the annual inspection from 09/21/2023. Present during today's inspection were 17 children and at least five staff. Facility was within ratio during today's inspection. The last fire drill was conducted on 08/23/2023.

During today's inspection, LPA continued review of children's files. The records reviewed include but not limited to admission agreement and personal rights.

LPA also continued review of staff files. The records reviewed include but not limited to Health Screening, TB test, and immunization records for measles and pertussis. LPA discussed with Principal to obtain proof of influenza for staff who are obtaining it by 12/01/2023.

Facility will submit the following:
- S-1's Health Screening with the date completed
- S-2's Health Screening, TB test, and immunization records for measles (MMR)

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Principal Violet Seryani. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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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