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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400312
Report Date: 04/06/2022
Date Signed: 04/06/2022 04:23:57 PM

Document Has Been Signed on 04/06/2022 04:23 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 HORIZONS-SAN JOSEFACILITY NUMBER:
434400312
ADMINISTRATOR:REBECCA ADAMSFACILITY TYPE:
830
ADDRESS:6120 LISKA LANETELEPHONE:
(408) 225-3276
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 32TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
04/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Emma NieTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz, conducted an unannounced case management inspection and met with Emma Nie, Health and Safety Director. LPA informed Emma that purpose of visit is to discuss Lead Sampling Testing conducted on 02/19/2022. Census was taken, LPA observed 8 children with 3 staff supervising. LPA informed Emma that the testing of water supply in Site F indicated an Action Level Exceedance, hence, water from this site is deemed not safe to drink or be used for food preparation due to elevated levels of lead. Emma provided LPA with water sampling report dated 03/09/2022 from Alpha Analytical Laboratories, Inc. that indicated result on Site F is above 5ppb.

LPA observed that a bag is placed over the affected water faucet on Site F making it inaccessible for use. Emma also stated that the room where Site F water faucet is located is currently not being used for daycare, only for storage purposes. Emma stated that the remediation process on Site F has started and a filtration system has been installed on the affected water faucet. Emma stated that currently, daily flushing of water from the faucet is done in preparation for the next water sampling scheduled on 4/27/22. Emma provided LPA with an updated water flushing schedule for Site F. Emma stated that bottled water is readily available for consumption on site. LPA observed hot and cold water dispensers with adequate supply of filled water bottles located in the facility's community room and staff room. Emma stated that the facility provides food for the children and water being used for food preparation comes from the water faucet located in their kitchen. Emma stated that facility is using filtered water from faucets inside the classrooms for drinking.

Based on LPA's record review and observation, the following violation is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101238 (a) Buildings and Grounds. See attached 809D.

Exit interview was completed and Appeal Rights were discussed with Emma Nie, Health & Safety Director.

A NOTICE OF SITE VISIT WAS ISSUED AND POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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 04/06/2022 04:23 PM - It Cannot Be Edited


Created By: Janette Cruz On 04/06/2022 at 03:51 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BRIGHT HORIZONS-SAN JOSE
FACILITY NUMBER: 434400312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2022
Section Cited
CCR
101238(a)

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101238(a)Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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Licensee will submit a written plan of action by POC date 4/20/22 providing remediation of repairs and retesting of water scheduled on 4/27/22. Licensee shall submit the water test report indicating allowable level of lead before use for drinking or cooking. Licensee have bottled waters available on site.
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Based on observations, interview and record review, the CCC Lead Sampling report for the facility indicated that water from one water outlet site has elevated lead greater than 5ppb which poses a potential health and safety or Personal risk to persons in care.
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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:Diana Stephenson
LICENSING EVALUATOR NAME:Janette Cruz
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022


LIC809 (FAS) - (06/04)
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