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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 354416102
Report Date: 06/10/2021
Date Signed: 06/10/2021 02:13:32 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-20210406094446
FACILITY NAME:HOLLISTER CHILD DEVELOPMENT CENTER, LLCFACILITY NUMBER:
354416102
ADMINISTRATOR:ALMA MAY BAYANI, PSYDFACILITY TYPE:
830
ADDRESS:331 GATEWAY DRIVETELEPHONE:
(831) 635-9284
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:20CENSUS: 5DATE:
06/10/2021
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Cristina BarrientosTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not change the daycare child when needed.
INVESTIGATION FINDINGS:
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LPA Deanna Villagrana met with Assistant Director Christina Barrientos to deliver findings for the above allegation. LPA observed five children in the Caterpillar room with one teacher, one aide and five infants.

Based on interviews conducted and pertinent documents obtained, it was determined the facility failed to keep infants clean and dry at all times resulting in a child developing a diaper rash. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following Type b deficiency was cited on the attached page (809-D). Appeal rights were provided to the Director prior to the conclusion of today's inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20210406094446
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: 354416102
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2021
Section Cited
CCR
101428(b)
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Infant Care Personal Services
The infant shall be kept clean and dry at all times.
This requirement was not met as evidenced by the facility failed to keep infants clean and dry at all times resulting in a child developing a diaper rash.
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Director Cristina Barrientos will conduct a meeting with all infant staff and delegate one staff to input all parent notifications including diaper changes into preschool. Cristina will have a backup plan if preschool system is not working. Cristina will submit plan and meeting notes inlcuding staff signatures regarding meeting.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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: 06/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2