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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420967
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:40:28 PM

Document Has Been Signed on 09/28/2023 12:40 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BRIGHT HORIZONS AT DUBLINFACILITY NUMBER:
013420967
ADMINISTRATOR:NEIBERGER, SUSANFACILITY TYPE:
830
ADDRESS:7035 DUBLIN BLVD.TELEPHONE:
(925) 479-9573
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 19DATE:
09/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Director, Susan NeighbergerTIME COMPLETED:
01:00 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Saini met with Director Susan Neiberger for an unannounced case management inspection in response to an Unusual Incident that the Facility self reported to the Department on 09/14/2023.

LPA Saini conducted interviews with the center director and staff and obtained documents. Based on the interviews and record reviews, the Facility acknowledged that during the transition from the playground to the classrooms, a toddler (C1) was left unattended in the playground for approximately 5 minutes. The staff failed to complete the name-to-face roll call or sweep the playground prior to leaving, which concludes that staff did not provide adequate supervision to children in care. California Code of Regulations, {Title 22, Division & Chapter Number 101229(a)(1)} is being cited on the attached LIC 809D.

LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

An immediate civil penalty of 500$ is assessed today.



An exit interview was conducted with director, Susan Neighberger

A notice of site visit was given and must remain posted for a period of 30 days.

The Facility's appeal rights were reviewed and given to the director, Susan Neiberger..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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Document Has Been Signed on 09/28/2023 12:40 PM - It Cannot Be Edited


Created By: Jyoti Saini On 09/28/2023 at 11:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BRIGHT HORIZONS AT DUBLIN
FACILITY NUMBER: 013420967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision:(a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation
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The director shall submit a written plan to the community care licensing division (CCLD) on how the facility and staff will always ensure complete supervision of all children in care. The director shall also conduct in-house training on care and supervision, provide a copy to all staff members, and have them sign the plan.

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Based on the interview and record review, toddler (C1) was left unattended in the playground which poses an immediate health and safety risk to children in care.
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An immediate civil penalty of 500$ is assessed today.

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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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023


LIC809 (FAS) - (06/04)
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