354416103-3-5-2020-07-CC-DVIA-BMF35B-20200305165628

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354416103
Report Date: 03/05/2020
Date Signed: 03/05/2020 04:56:34 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, LLC		FACILITY NUMBER:	354416103
ADMINISTRATOR:	ALMA MAY BAYANI, PSYD		FACILITY TYPE:	840
ADDRESS:	331 GATEWAY DRIVE		TELEPHONE:	(831) 625-9284
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	56	CENSUS: 19	DATE:	03/05/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Alma May Bayani		TIME COMPLETED:	05:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Deanna Villagrana met with Alma "May' Bayani, director, for a 1 year required visit. The school age program is Licensed in the Dragonflies room. The school age program hours: 1:00pm to 6:00pm Monday through Friday. The Facility also has a infant program (#354416102), as well as a preschool program (354416101) on site. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. LPA toured the Facility both inside and outside during today's inspection. LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA did not observe any bodies of water. LPA notes the playground is to the left of the classroom. LPA reviewed ten children's and two staff (1 teacher and 1 aide) files during today's inspection. LPA reviewed other teacher's files during other visits and observed all teacher's have required forms and immunizations. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). Teacher's file reviewed contains the required transcripts/verification of experience. LPA observed at least three staff have current CPR and First Aid certifications on file. May understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). May states that all children are picked up from the Facility by parents/authorized representatives.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 354416103
	VISIT DATE: 03/05/2020

NARRATIVE

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A review of staff records on 03/02/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded May of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 19 school age children with one teacher and 2 aides during today's inspection. May understands the conditions, limitations, and capacity specifications of the Facility license. May understands that children shall be visually supervised at all times.

LPA observed that all rooms are clean and safe for all children and staff. May states that the Facility has a third-party cleaning service that cleans the Facility daily in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via pitchers/disposable cups. LPA observed solid waste containers with tight-fitting lids in each room. Children's bathrooms were not sanitary and had leaks under the sinks causing mold. LPA observed water and soap all over the bathroom counter and floor. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. May states that there are no weapons or firearms on the premises. There is a functioning carbon monoxide detector in the Facility.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in locked cabinets. Medications are stored in each classroom in an appropriate lock box. No IMS is being administered to children at the facility.

The following type B deficiency was cited on the attached page (809-D). May was informed that failure to correct the deficiencies 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.

An exit interview was conducted and Plan of Correction was reviewed and developed with May. A copy of this report and appeal rights were discussed and left with May, whose signature on this form confirms receipt of these documents.

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

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 354416103
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/05/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/12/2020 Section Cited	1 2 3 4 5 6 7	101238(a) Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by Children's bathrooms were not
	8 9 10 11 12 13 14	sanitary and had leaks under the sinks causing mold. LPA observed water and soap all over the bathroom counter and floor. This poses a potential risk Health, Safety Personal Rights risk 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

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

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