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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404373
Report Date: 03/09/2023
Date Signed: 03/09/2023 12:09:11 PM


Document Has Been Signed on 03/09/2023 12:09 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:STARBRIGHT SCHOOLFACILITY NUMBER:
434404373
ADMINISTRATOR:ALLA USHOMIRSKYFACILITY TYPE:
850
ADDRESS:4645 ALBANY DRIVETELEPHONE:
(408) 985-1460
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:90CENSUS: 50DATE:
03/09/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Anastasia KuTIME COMPLETED:
12:30 PM
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On 03/09/2023, Licensing Program Analyst (LPA) Pete Hernandez, met with Director, Anastasia Ku , for a case management Lead Testing/ Exceedance visit in regards to the lead testing results submitted by the facility and explained the reason for the visit to them. Present were 10 staff with 50 children in care.

Facility submitted that there is an exceedance of about 9.2 (ppb) sample (B) room 2 from the drinking fountain attached to the sink. Director stated that the above has been permanently disabled. The fountain has been disabled and will not be replaced when a new sink is installed. The facility uses water for the staff and children from other faucets with water filters that have passed lead safety testing of 5.5 (ppb) or less. The children in care use their own Sippy cups to drink water.

Type B deficiency was cited during today's visit. Director was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Exit interview conducted and report was reviewed with the Director, Anastasia Ku,
A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023
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


Document Has Been Signed on 03/09/2023 12:09 PM - 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: STARBRIGHT SCHOOL
FACILITY NUMBER: 434404373

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited

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101700.3(b)(1)
Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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By the POC date 3/10/2023: Facility will provide plan of correction in writing to CCLD regarding the Identified fixture is not to be used and remain disabled until cleared for use after retesting.
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Facility submitted that there is an exceedance of about 9.2 (ppb) sample (B) room 2 from the drinking fountain attached to the children's sink. This poses a potential risk to the children.
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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: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023
LIC809 (FAS) - (06/04)
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