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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 354416101
Report Date: 06/17/2021
Date Signed: 06/17/2021 01:08:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2021 and conducted by Evaluator Deanna Villagrana
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210406085840
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:30CENSUS: 22DATE:
06/17/2021
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Cristina BarrientosTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Authorized representive arrived at daycare to find the child covered in excrement.
Staff did not change the daycare child's diaper.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Deanna Villagrana met with director Cristina Barrientos to deliver findings for above allegations. LPA observed one teacher with 14 children in the large playground next to the preschool room and eight children with one teacher in the small playground behind the preschool. Director May Bayani arrived several hours later.

Based on LPA's interviews which were conducted and documents obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Staff did not change child's diaper in a timely manner resulting in child getting excrement on hands and clothing. California Code of Regulations, Health and Safety Code 1596.80, are being cited on the attached LIC9099D.

Notice of site visit was issued and must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
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 4
Control Number 07-CC-20210406085840
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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, LLC
FACILITY NUMBER: 354416101
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2021
Section Cited
CCR
101152(c)(3)(A)
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Assistance in diapering, toileting, dressing, grooming, bathing and other personal hygiene. This requirement was not met as evidenced by Staff did not change child's diaper in a timely manner resulting in child getting excrement on hands and clothing.
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Director Cristina Barrientos will conduct a meeting with all preschool staff on procedures for diaper changing. Cristina will submit plan and meeting notes including staff signatures regarding meeting.
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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.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2021 and conducted by Evaluator Deanna Villagrana
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210406085840

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:30CENSUS: 22DATE:
06/17/2021
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Cristina BarrientosTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not report an incident to the authorized representative in a timely manner.
Staff handled daycare children roughly.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Deanna Villagrana met with director Cristina Barrientos to deliver findings for above allegations. LPA observed one teacher with 14 children in the large playground next to the preschool room and eight children with one teacher in the small playground behind the preschool. Director May Bayani arrived several hours later.

Based on interviews conducted, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. It is unknow when child soiled their diaper before mother arrived and not enough evidence to prove staff handled daycare child roughly.

No deficiency was cited.

Notice of site visit was issued and must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4