<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412709
Report Date: 07/13/2022
Date Signed: 07/13/2022 04:07:08 PM


Document Has Been Signed on 07/13/2022 04:07 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:BRIGHT STARZFACILITY NUMBER:
434412709
ADMINISTRATOR:MARIA NAVARROFACILITY TYPE:
850
ADDRESS:810 WASHINGTON STREETTELEPHONE:
(408) 564-0863
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:24CENSUS: 23DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria NavarroTIME COMPLETED:
04:15 PM
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
Licensing Program Analyst (LPA) Mel Matos conducted an unannounced case management inspection and met with Maria Navarro, Licensee/Director.

LPA advised Maria that all staff and children's files must have the most current version of the
Department forms. LPA provided Maria with the Records to be Maintained at the Facility (LIC 311A) handout to Maria and provided her with the department website: www.ccld.ca.gov where she can also obtain the current version of the required Department forms.

LPA reminded Maria that she needs to have the most current version of the Department forms that are required to be posted on her bulletin board, located near the front entrance to the Facility.

No deficiencies issued during today's inspection.

Notice of site visit issued and must remain posted for 30 days.


SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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 1