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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001652
Report Date: 01/28/2020
Date Signed: 01/28/2020 01:27:55 PM

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 @ GILEAD (INFANT)FACILITY NUMBER:
414001652
ADMINISTRATOR:CINDY USNERFACILITY TYPE:
830
ADDRESS:301 VELOCITY WAYTELEPHONE:
(650) 312-1895
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:36CENSUS: 16DATE:
01/28/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Regional Manger, Nikki Mead TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Kassandra Medrano conducted and unannounced facility inspection. 15 minutes before this inspection an incident occurred. A child in the care of the child's mother noticed child was very pale and unresponsive. Parent called 911 and emergency response teams responded and preformed CPR. Child was then transported to Stanford hospital with mother and staff member. LPA collected staff files, childrens roster, and a timeline of events during visit.

No deficiencies were issued today under Title 22, Division 12 of the California Code of Regulations






This report and notice of site visit were discussed with the licensee and must be made available to the public upon request.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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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