STRATFORD SCHOOL - MISSION VIEJO

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Case Management Incident inspection, in response to an Unusual Incident Report submitted to the Licensing office on 4/6/22. LPA and the facility representative toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 46 preschool children with 4 preschool staff. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. An Unusual Incident Report UIR LIC624 form was submitted to the Licensing office on 4/6/22 detailing that a child #1 (see Confidential Names List LIC811) had injured their arm while playing on the outdoor play structure. It was later determined that the child #1 sustained a fracture in their wrist. The injury occurrence that led to the fracture was not witnessed by preschool staff. During today's inspection, LPA Valencia conducted a physical plant inspection of the facility, observed the classrooms/physical plants, took pictures of outdoor play structure, and interviewed staff and child #1 about the incident and supervision at the facility. It was determined from the information available to LPA during the inspection and investigation into the incident involving child #1 on 4/6/22, that there were approximately 22 to 23 children playing on the outdoor play area with 2 preschool staff (staff #2, and staff #3), and the child #1 had fallen off of a hanging bar about 3 feet, on to their right arm. The child went and hid under the structure then went to sit on the slide, where a staff #2 witnessed the child sulking and spoke with the child. Both staff #2 and Staff #3 were supervising children but child #1's injury and fall was not witnessed. Based on the information gathered by LPA it was determined that the facility had violated Title 22 Regulation section 101229(a)(1) related to Supervision. A printout of Title 22 Regulation Supervision was reviewed and provided to the facility representative during the inspection. (continued on LIC809C) SUPERVISORS NAME: Judy Hanson LICENSING EVALUATOR NAME: Dean Valencia LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY NAME: STRATFORD SCHOOL - MISSION VIEJOFACILITY NUMBER: 304371162 VISIT DATE: 04/13/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32(page 2) Based on LPAs observations and interviews the following violation is being cited in accordance with California Code of Regulations, Title 22 Section 101229(a)(1) , is/are being cited on the attached LIC 809D. Due to the facility being cited a Type A violation, the licensee must post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00 Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee SUPERVISORS NAME: Judy Hanson LICENSING EVALUATOR NAME: Dean Valencia LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022 FACILITY NAME: STRATFORD SCHOOL - MISSION VIEJO FACILITY NUMBER: 304371162 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/13/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 04/13/2022 Section Cit

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Case Management Incident inspection, in response to an Unusual Incident Report submitted to the Licensing office on 4/6/22. LPA and the facility representative toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 46 preschool children with 4 preschool staff. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. An Unusual Incident Report UIR LIC624 form was submitted to the Licensing office on 4/6/22 detailing that a child #1 (see Confidential Names List LIC811) had injured their arm while playing on the outdoor play structure. It was later determined that the child #1 sustained a fracture in their wrist. The injury occurrence that led to the fracture was not witnessed by preschool staff. During today's inspection, LPA Valencia conducted a physical plant inspection of the facility, observed the classrooms/physical plants, took pictures of outdoor play structure, and interviewed staff and child #1 about the incident and supervision at the facility. It was determined from the information available to LPA during the inspection and investigation into the incident involving child #1 on 4/6/22, that there were approximately 22 to 23 children playing on the outdoor play area with 2 preschool staff (staff #2, and staff #3), and the child #1 had fallen off of a hanging bar about 3 feet, on to their right arm. The child went and hid under the structure then went to sit on the slide, where a staff #2 witnessed the child sulking and spoke with the child. Both staff #2 and Staff #3 were supervising children but child #1's injury and fall was not witnessed. Based on the information gathered by LPA it was determined that the facility had violated Title 22 Regulation section 101229(a)(1) related to Supervision. A printout of Title 22 Regulation Supervision was reviewed and provided to the facility representative during the inspection. (continued on LIC809C) SUPERVISORS NAME: Judy Hanson LICENSING EVALUATOR NAME: Dean Valencia LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY NAME: STRATFORD SCHOOL - MISSION VIEJOFACILITY NUMBER: 304371162 VISIT DATE: 04/13/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32(page 2) Based on LPAs observations and interviews the following violation is being cited in accordance with California Code of Regulations, Title 22 Section 101229(a)(1) , is/are being cited on the attached LIC 809D. Due to the facility being cited a Type A violation, the licensee must post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00 Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee SUPERVISORS NAME: Judy Hanson LICENSING EVALUATOR NAME: Dean Valencia LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022 FACILITY NAME: STRATFORD SCHOOL - MISSION VIEJO FACILITY NUMBER: 304371162 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/13/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 04/13/2022 Section Cit

Type A citation - immediate risk to health, safety, or personal rights