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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415794
Report Date: 06/10/2021
Date Signed: 06/11/2021 08:08:12 AM

Document Has Been Signed on 06/11/2021 08:08 AM - 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 STEVENS CREEKFACILITY NUMBER:
434415794
ADMINISTRATOR:NANCY CAMPBELLFACILITY TYPE:
850
ADDRESS:4945 STEVENS CREEK BOULEVARDTELEPHONE:
(408) 990-8920
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 122TOTAL ENROLLED CHILDREN: 0CENSUS: 35DATE:
06/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sherron Murphy-BrownTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Anna Morales and OSCAR HUANG conducted a Case Management Visit and was greeted by Executive Director Sherron Murphy-Brown.. The purpose for this visit was in response of an Incident that occurred on 6/8/2021 stating that an child who has an allergy to dairy was given a lunch meal with dairy causing an allergic reaction.

LPA's conducted interviews with Director Brown, a Health and Safety Coordinator and one teacher who were present when the incident occurred. LPA's, also, toured the classroom and observed the meal prep room. LPA's reviewed child record's and including medications. Incidental Medical Services was followed and child was given medication properly and parents were informed immediately and took child to hospital to seek medical treatment.
Executive Director stated that the child came back to the center on 6/10/2021.

As a result of this investigation, a Type B deficiency was cited on the following page, LIC809 D.



NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

Exit Interview was conducted with the Executive Director and APPEALS RIGHT were given.
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SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2021
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 06/11/2021 08:08 AM - It Cannot Be Edited


Created By: Anna Morales On 06/10/2021 at 01:04 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 AT STEVENS CREEK
FACILITY NUMBER: 434415794

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2021
Section Cited
CCR
101227(a)(7)(B)

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101227 Food Services:(7) Modified diets prescribed by a child's physician as a medical necessity shall be provided.
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Executive Director agreed to send the Facility Food Handling process to ensure that this will not occurr again in the future, and will send the monthly agenda including Food Handling Topic with staff's signature by the POC date.
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(B) A child shall not be served any food to which the child's record indicates he/she has an allergy.
This was not met by: A child who has an allergy to dairy was given meal with diary which caused an allergic reaction.This poses a potential risk to the Health, Safety, or Personal Rights of children 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:Sandy Knight
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2021


LIC809 (FAS) - (06/04)
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