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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415795
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:25:30 PM

Document Has Been Signed on 09/13/2023 03:25 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BRIGHT HORIZONS AT STEVENS CREEKFACILITY NUMBER:
434415795
ADMINISTRATOR:NANCY CAMPBELLFACILITY TYPE:
830
ADDRESS:4945 STEVENS CREEK BOULEVARDTELEPHONE:
(408) 990-8920
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 41DATE:
09/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sherron MurphyTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management inspection regarding an Unusual Incident that was reported by the facility to Licensing on 8/16/2023. LPA was greeted by Director Sherron Murphy. LPA toured the facility, interviewed staff, reviewed files, and obtained copies of documents.

Based on interviews and evidence gathered, it was determined that on August 16,2023, approximately at 5:27pm, a Infant aged child was left unattended in the hallway outside the Early Preschool 2 Classroom. This poses an immediate risk to the health, safety, and personal rights to children in care.

A Type A citation was issued at today's visit, and a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for the next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files. The citation warrants an immediate civil penalty of $500.00 and is hereby assessed, See LIC421IM. An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Director.

Appeal Rights Given.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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 09/13/2023 03:25 PM - It Cannot Be Edited


Created By: Anna Morales On 09/13/2023 at 02:06 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: 434415795

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision(a)(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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 Director stated that she will submit the plan that was reviewed on 8/31/23 at the ALL STAFF MEETING. PLAN reviewed the supervision policy and strategies for sight and sound superivision during drop off and pick up. This is to be submitted by the POC date. This is a zero-tolerance violation, an immediate civil penalty of $500 was assessed during the
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This requirement was not met as evidenced by: A child was left unattended in the Hallway outside of Early Preschool 2 on 8/16/23.This is a zero tolerance violation. This poses an immediate risk to the health, safety, and personal rights to children in care.
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 inspection.Upon receipt, Director shall post and provide copies of this licensing report, have LIC 9224 signed and kept on file, to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months & copy of the signed acknowledgment form must be kept in each child's file.

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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023


LIC809 (FAS) - (06/04)
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