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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416363
Report Date: 12/07/2022
Date Signed: 12/07/2022 11:01:37 AM

Document Has Been Signed on 12/07/2022 11:01 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BRIGHT SUNRISE PRESCHOOL EVERGREENFACILITY NUMBER:
434416363
ADMINISTRATOR:LOC KERWINFACILITY TYPE:
850
ADDRESS:3520 SAN FELIPE RD. BLDG. 2TELEPHONE:
(669) 226-8782
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 60TOTAL ENROLLED CHILDREN: 25CENSUS: 24DATE:
12/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle JacksonTIME COMPLETED:
11:15 AM
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On December 7th, 2022 at 9:30am Licensing Program Analyst (LPA) Kassandra Medrano met with Facility representative, Michelle Jackson for an unannounced case management inspection. The purpose of the inspection was explained to the facility representative. The purpose of the inspection was to investigate an incident that the facility self reported to Community Care Licensing Department (CCLD) on 4/29/2022. On 4/29/2022, the facility reported that on 4/28/2022, a child was left alone in yard during transition back into facility after outdoor play. During the time of the incident facility was not licensed by community care licensing and had been cited for unlicensed care.LPA spoke to facility representative about plans for remediation and prevention of repeating incident.

Due to the unlicensed status of the facility at the time of the incident, no deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.



Exit interview conducted and report was reviewed with the Facility Representative, Michelle Jackson.
"NOTICE OF SITE VISIT" WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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