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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354416101
Report Date: 06/10/2021
Date Signed: 06/10/2021 03:10:53 PM

Document Has Been Signed on 06/10/2021 03:10 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:HOLLISTER CHILD DEVELOPMENT CENTER, LLCFACILITY NUMBER:
354416101
ADMINISTRATOR:ALMA MAY BAYANI, PSYDFACILITY TYPE:
850
ADDRESS:331 GATEWAY DRIVETELEPHONE:
(831) 635-9284
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 22DATE:
06/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Cristina BarrientosTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Deanna Villagrana met with Director Cristina Barrientos for a Case Management visit. LPA observed 15 children in the Firefly room with one teacher and one aide and seven children in the Bumblebee room with teacher Araceli Pineda and one aide Isabella Maria Lopez.

A review of staff records on 06/10/2021 indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA observed Araceli Pineda and Isabella Maria Lopez did not have criminal record clearance. Araceli Pineda start date was 01/22/2021 and Isabella Maria Lopez start date was 03/01/2021 Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevents them from returning to the home or having contact with children in care.

LPA discussed the requirements of AB633 to director and director understands the requirements. Upon receipt, director shall post and provide copies of this licensing report 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.

The following Type A deficiency was cited on the attached page (809-D). Appeal rights were provided to Cristina prior to the conclusion of today's inspection. A civil penalty of $1,000.00 was assessed for two staff members not having fingerprint clearance.

Notice of site visit was issued and must be posted with type A deficiency for 30 days.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
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 06/10/2021 03:10 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 06/10/2021 at 02:55 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: HOLLISTER CHILD DEVELOPMENT CENTER, LLC
FACILITY NUMBER: 354416101

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2021
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption.
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Director Christina Barrientos removed Araceli Pineda and Isabella Maria Lopez and understands they are not to return to work until they are cleared. A $1,000 civil penalty was assessed during visit.
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This requirement was not met as evidenced by LPA observed Araceli Pineda and Isabella Maria Lopez did not have criminal record clearance.
This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
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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