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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413153
Report Date: 09/22/2020
Date Signed: 09/24/2020 03:13:22 PM

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:BRIGHTSTAR CHRISTIAN ACADEMY PRESCHOOLFACILITY NUMBER:
434413153
ADMINISTRATOR:JACQUELINE ALKHASEHFACILITY TYPE:
850
ADDRESS:1513 KOOSER ROADTELEPHONE:
(408) 266-7600
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:97CENSUS: 34DATE:
09/22/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:JUSTIN FRASER - Executive DirectorTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Ofelia Calivo and Anna Morales conducted a Tele-Inspection Case Management via video conference call (FaceTime) in regards to an unusual incident report received on September 18, 2020.

LPAs interviewed Executive Director Justin Fraser regarding their transitional procedure. LPAs requested a copy of the transitional policy and protocol from Executive Director to be submitted to LPA by September 29, 2020.

Executive Director Justin Fraser was informed that due to COVID-19 situation, this Facility Evaluation Report (LIC 809) will be emailed to Justin Fraser at: admin@mybrightstarca.com. A reply to the email within 24 hours will serve as acknowledgement that the report was received.

No deficiency is being cited at this time.

An exit interview was conducted with Licensee and a Notice of Site Visit was issued, which must be posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia CalivoTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020
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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