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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354416103
Report Date: 07/01/2019
Date Signed: 07/01/2019 01:00:33 PM

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:
354416103
ADMINISTRATOR:ALMA MAY BAYANI, PSYDFACILITY TYPE:
840
ADDRESS:331 GATEWAY DRIVETELEPHONE:
(831) 625-9284
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:56CENSUS: 7DATE:
07/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Cristina BarrientosTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Joe Macias conducted a Case Management Inspection. LPA met with the Site Supervisor Cristina Barrientos, and explained the nature of today's visit. The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. Todays census is 7 children and 1 fully qualified teacher. The school age program hours of operation are currently 6:30am - 6pm, due to the summer schedule.

While conducting a case management inspection on March 13, 2019 LPA observed the facility out of ratio. LPA observed one staff to 19 children. The facility has since submitted the plan of correction. LPA also reviewed the school age pick up schedule with the Site Supervisor. The Site Supervisor stated there will always be a fully qualified teacher in the school age program. The Site Supervisor stated the facility has hired additional staff to assist in supervision and maintaining ratio. LPA once again expressed the importance of maintaining ratio.

LPA reminded the Director that there shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance. A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. Staffing requirements for mixed-age groups shall be determined based on the age of the youngest child in the group. The director may be counted in the ratio when actually working with a group of children.

LPA also reviewed staff records to ensure all staff are fully qualified.

No deficiency cited, exit interview conducted, and a copy of this report was provided to the facility.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2019
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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