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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002478
Report Date: 07/17/2019
Date Signed: 08/05/2019 08:49:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BRIGHT HORIZONS AT KANSAS STREET (INF)FACILITY NUMBER:
384002478
ADMINISTRATOR:HOBSON, JENNYFACILITY TYPE:
830
ADDRESS:200 KANSAS STREET, STE. 100TELEPHONE:
(415) 863-2533
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:64CENSUS: 46DATE:
07/17/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Directors, Jenny Hobson/ Lauren DahiaTIME COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Luis J. Gomez conducted a case management inspection today in response to an incident report received from the facility on June 21, 2019. The incident involved an infant (C1) and a staff member. Based on LPA interviews with the director and staff who had witnessed the incident, it was confirmed that on 6/21/2019, child (C1) was forced by a staff member to put his fingers in his own mouth and asked to bite himself. Director stated that the staff member was placed on administrative leave after the incident and has since resigned from the facility.

After meeting with staff, it was determined that the incident was handled in an appropriate and timely manner.

A Plan of Correction was discussed with site directors. On 6/26/2019, facility held a staff meeting/ training to discuss children's Personal Rights and facility protocol regarding the proper care of the children. The sign-in sheet from the training was provided to licensing. As a result of the occurrence of this incident, a violation of the Title 22 regulations was observed and a deficiency is being cited today.

Refer to deficiencies on the next page...

This report and a Notice of Site Visit are provided. Due to Technical Issues during the inspection, this report will be mailed to director and returned to licensing at a later date.

Original Signed copies will remain in the facility file at the childcare regional office.

Notice of Site Visit was given. >This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.

Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BRIGHT HORIZONS AT KANSAS STREET (INF)
FACILITY NUMBER: 384002478
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2019
Section Cited
CCR
101216.3(a)
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101216.3 Personal Rights. Each child shall be free from corporal or unusual punihsment, humiliation, intimidation, ridicule, coercion, threat, mentakl abuse, or other action of a punitive nature.
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POC completed. Facility held staff meeting/ training addressing children's personal right's and facility policy. Director submitted copy of sign-in sheet and topics dicussed during meeting with staff to licensing.
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The requirement is not met as evidenced by; On 6/21/2019, child (C1) was forced by a staff member to put his fingers in his own mouth and asked to bite himself. This is a potential health and safety risk to 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: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
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