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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354416101
Report Date: 08/03/2021
Date Signed: 08/03/2021 12:06:59 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:
354416101
ADMINISTRATOR:ALMA MAY BAYANI, PSYDFACILITY TYPE:
850
ADDRESS:331 GATEWAY DRIVETELEPHONE:
(831) 635-9284
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:30CENSUS: 0DATE:
08/03/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alma May BayaniTIME COMPLETED:
12:10 PM
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Regional Manager (RM) Anthony Studebaker, Licensing Program Manager (LPM) Mary Segura and Licensing Program Analyst (LPA) Deanna Villagrana met with Director Alma May Bayani at the San Jose Regional Office today for a scheduled Non-Compliance Conference (NCC). The purpose of today's NCC is to discuss the facility compliance and ability to follow Title 22 Regulations.

RM Anthony Studebaker explained the purpose of the NCC and the administrative process. Director May was advised that continued non-compliance of Title 22 Regulations could result in facility being referred to our legal department for review and possible action against the license. The director understands that the Community Care Licensing will increase monitoring of the facility for the next twelve months.

Director, Alma May Bayani, was provided a copy of the LIC9111 (Non-Compliance Conference Summary) during today's meeting.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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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