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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354416101
Report Date: 12/20/2023
Date Signed: 12/20/2023 12:15:06 PM

Document Has Been Signed on 12/20/2023 12:15 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
SAN JOSE CC RO, 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: 30CENSUS: 26DATE:
12/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Esperanza FloresTIME COMPLETED:
12:25 PM
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LPAs Deanna Villagrana and Doni Fici met with Jennifer S De La Cruz, aide. LPAs explained the reason for the visit. Jennifer stated teacher Esperanza Flores was in charge since Director Alma May Bayani is on vacation. LPAs observed 13 children with one teacher and one aide in the Fireflies room and 13 children with one teacher and one aide in the Bumblebee room.

LPAs conduct interview with staff regarding and unusual incident that was reported on 10/17/2023. Due to insufficient information regarding incident, LPAs could not gather enough information to cite. Further investigation will be conducted at a later date.

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: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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