354416101-10-12-2023-07-CC-SCES-CWQV2Z-20231018160355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 354416101
Report Date: 10/12/2023
Date Signed: 10/12/2023 01:35:12 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
10/09/2023 and conducted by Evaluator Deanna Villagrana

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20231009171259

FACILITY NAME:	HOLLISTER CHILD DEVELOPMENT CENTER, LLC		FACILITY NUMBER:	354416101
ADMINISTRATOR:	ALMA MAY BAYANI, PSYD		FACILITY TYPE:	850
ADDRESS:	331 GATEWAY DRIVE		TELEPHONE:	(831) 635-9284
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	30	CENSUS: 26	DATE:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Alma May Bayani		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Lack of Supervision

INVESTIGATION FINDINGS:

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LPA Deanna Villagrana met with Director/Owner Alma May Bayani to open investigation for above allegation. LPA observed 26 preschool children with two teachers and three assistants in the preschool playground during visit.

Based on interview, which was conducted, the preponderance of evidence standard has been met, therefore the above allegation was found to be Substantiated. California Code of Regulations, (Title 22, Division 12, Chapter 1) 102370(d)(1). A child was left alone in the preschool playground unsupervised.

The following type A deficiency was cited on the attached page (809-D). Director was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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 3

Control Number 07-CC-20231009171259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HOLLISTER CHILD DEVELOPMENT CENTER, LLC	FACILITY NUMBER: 354416101
	VISIT DATE: 10/12/2023

NARRATIVE

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LPA Deanna Villagrana informed licensee Alma May Bayani that this report dated 10/12/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Alma May Bayani to provide a copy of this licensing report dated 10/12/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 07-CC-20231009171259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 10/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/13/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.	1 2 3 4 5 6 7	Licensee will conduct a meeting with staff regarding supervision and submit meeting notes to CCLD by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by a child was left alone in the preschool playground unsupervised. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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