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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005558
Report Date: 09/28/2022
Date Signed: 09/28/2022 11:10:16 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2022 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20220818110339
FACILITY NAME:BRIGHT STARS CHILDREN'S CENTERFACILITY NUMBER:
214005558
ADMINISTRATOR:TALEBLOO, NAHIDFACILITY TYPE:
830
ADDRESS:199 GREENFIELDTELEPHONE:
(415) 310-7543
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:19CENSUS: 13DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Irma De Leon & Nahid TaleblooTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not immediately notify child's authorized person of the nature of injuries or inquire about actions that should be taken regarding child's injuries.
INVESTIGATION FINDINGS:
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On September 27, 2022 at approximately 10:00am, Licensing Program Analyst (LPA) Ly arrived at facility and met with Lead Teacher Irma De Leon to close this complaint. The purpose of the inspection was explained. Director Nahid Talebloo arrived to the facility approximately ten minutes after LPA arrived. Present during the visit were Director and 4 staff caring for 13 infants and toddlers.

During the course of investigation, LPA reviewed records, conducted interviews, and obtained copies of pertinent documents. Based on information gathered, the allegation (1) Staff did not immediately notify child's authorized person of the nature of injuries or inquire about actions that should be taken regarding child's injuries, the preponderance of evidence standard has been met. Therefore, the above-listed allegations are found to be SUBSTANTIATED.

A copy of this report and notice of site visit were discussed and left with Director Nahid Talebloo whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20220818110339
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BRIGHT STARS CHILDREN'S CENTER
FACILITY NUMBER: 214005558
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2022
Section Cited
CCR
101226
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101226
(a) The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken.
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Director will train the staff regarding injuries of children and send proof of training sign by each staff in attendance to LPA by 10/10/2022.
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This requirement is not met as evidenced by: Based on interviews with staff
and child’s parent, Staff did not notify parents or child’s authorized representatives of
child’s incident/injury in a timely manner to ensure child did not need medical attention. This
poses a potential risk to children in care.
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Type B
09/28/2022
Section Cited
CCR
101417
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101417
(a) Licensees serving infants may create a special program component for children who are between 18 months and 36 months of age. The provisions of Sections 101151 through 101239.2 and 101351 through 101439.1 shall apply to infant care centers operating a toddler component in addition to those specified in Health and Safety Code section 1596.956.

(1) The infant care center shall obtain written permission from the child's authorized representative for the placement of the child in the toddler program.
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Director will train staff regarding transitioning infants into toddler program and send proof of training sign by each staff in attendance to LPA by 10/10/2022.
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This requirement is not met as evidenced by: Based on interviews with staff and child’s parent, consent was not obtain before transition child to toddler program.
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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.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2