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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415097
Report Date: 06/02/2021
Date Signed: 06/02/2021 01:10:26 PM

Document Has Been Signed on 06/02/2021 01:10 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 LITTLE MINDS PRESCHOOL & DAYCAREFACILITY NUMBER:
434415097
ADMINISTRATOR:IVY LAUFACILITY TYPE:
850
ADDRESS:30 KIRK AVENUETELEPHONE:
(408) 216-7203
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 16DATE:
06/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ivy LauTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Marilou Monico and James Santos conducted a case management inspection. Based on LPA's interviews, Akanksha Gupta, started working yesterday, June 1, 2021, without fingerprint clearance associated to the facility.

Type B deficiency was cited on the following page:

Civil penalty of $100.00 was assessed.

NOTICE OF SITE VISIT WAS ISSUED. SITE DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2021
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 06/02/2021 01:10 PM - It Cannot Be Edited


Created By: Marilou Monico On 06/02/2021 at 12:31 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 LITTLE MINDS PRESCHOOL & DAYCARE
FACILITY NUMBER: 434415097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2021
Section Cited
CCR
101170(e)(2)

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CRIMINAL RECORD CLEARANCE - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance.
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Site Director submitted Criminal Background Clearance Transfer Request (LIC 9182) together with Akanksha's identification to Licensing today.

Deficiency corrected.
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This requirement is not met as evidenced by: Akanksha Gupta started working on June 1, 2021 without fingerprint clearance associated to the facility. This poses a potential risk to the health and safety of children in care.

Civil penalty of $100 was assessed.
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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:Anthony Studebaker
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2021


LIC809 (FAS) - (06/04)
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