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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415530
Report Date: 11/01/2021
Date Signed: 11/01/2021 09:02:58 PM

Document Has Been Signed on 11/01/2021 09:02 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 AT SUNNYVALEFACILITY NUMBER:
434415530
ADMINISTRATOR:DONALDSON, KIMEESEANFACILITY TYPE:
850
ADDRESS:1010 SUNNYVALE-SARATOGA AVENUETELEPHONE:
(669) 241-0040
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 146TOTAL ENROLLED CHILDREN: 146CENSUS: 71DATE:
11/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Kylie RichardsonTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA), Joseph Macias, conducted an unannounced Case Management/ Incident Inspection in response to an unusual incident that the facility self reported to Community Care Licensing (CCL). LPA met with the Site Supervisor Kylie Richardson, and explained the nature of today's visit.

This inspection was made to inquire about unusual incidents that occurred on October 4, 2021.

During today's visit LPA Macias toured the facility, interviewed staff, and obtained copies of pertinent documentation. Based on interviews, as well as the self reported incident report; a child's personal rights were violated.

Since the incidents occurrence Bright Horizons has been proactive in self reporting to CCL as well as CPS. Bright Horizons has immediately implemented several interventions: staff training's, professional development, and disciplinary actions. LPA Macias reviewed with the Director that each child is accorded the following personal rights: to be accorded dignity in his/her personal relationships with staff and other persons. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.

As a result of this Inspection, a deficiency was cited.

Appeal right were printed and reviewed with the staff.

Type B deficiency cited, exit interview conducted, and a copy of this report was provided to the facility.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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 11/01/2021 09:02 PM - It Cannot Be Edited


Created By: Joseph Macias On 11/01/2021 at 10:57 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BRIGHT HORIZONS AT SUNNYVALE
FACILITY NUMBER: 434415530

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2021
Section Cited
CCR
101223(a)(3)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.
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Since the incidents occurrence Bright Horizons has immediately implemented several interventions: staff training's, professional development, and disciplinary actions.
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Based on interviews, as well as the self reported incident report; a child's personal rights were violated. This poses a potential risk to the health, safety, and personal rights of the children in care.
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The Program Director shall submit proof of training's and interventions to CCL by the POC date.

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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:Sandy Knight
LICENSING EVALUATOR NAME:Joseph Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2021


LIC809 (FAS) - (06/04)
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