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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419473
Report Date: 10/02/2019
Date Signed: 10/02/2019 02:53:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CITY OF UNION CITY - HOLLY CENTERFACILITY NUMBER:
013419473
ADMINISTRATOR:VERA, MARISSAFACILITY TYPE:
850
ADDRESS:31600 ALVARADO BLVD.TELEPHONE:
(510) 675-5488
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:19CENSUS: 16DATE:
10/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Marissa VeraTIME COMPLETED:
03:15 PM
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On 10/2/19, Licensing Program Analyst (LPA) Briana Plumboy met with Director Marissa Vera for an unannounced random inspection. The center and playground were toured to conduct a Health and Safety inspection. There are 16 children present during the visit. Also present for the visit was 3 staff. This facility currently operates from 7:00am until 6:00pm.

The center consists of 1 room, an adjacent napping room, and an auditorium which is cleared for extra space when dedicated to preschool children only which appears to be safe, clean and in good repair during today's inspection. There is storage for children's belongings. There is furniture, toys and activities which are age appropriate and in good condition. The heating and lighting is adequate. There is drinking water readily available to children. There is a combined bathroom for boys and girls. All toilets flush properly, and there is running water, soap, and paper towels available for children to wash and dry their hands. There is a separate bathroom for staff. There are no bodies of water, or free standing water, accessible to children during today's inspection. Per site supervisor, there are no firearms on the premises of the child care center. The food preparation area is clean, free from hazards and adequately equipped. There is a menu posted, and there are no cleaning supplies stored with food. The lunches are provided by families and the snacks are provided by the center. There are ample mats and sheets available for children's use, and they are stored properly. The playground has play equipment. All required documents are posted for public review. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months, and the log indicates the last one done was on 09/24/19. The center is equipped with a first aid Kit, working telephone, carbon monoxide detector, pull down fire alarm, and a 3A40BC fire extinguisher. LPA observed the interaction between the staff and children in care, and found it to be in compliance with the Title 22 Regulations.
All staff have current immunization's and mandated reporter training certificates. At least one opening/closing staff member has a current CPR/First Aid certificate. SEE 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CITY OF UNION CITY - HOLLY CENTER
FACILITY NUMBER: 013419473
VISIT DATE: 10/02/2019
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

California Law requires Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

The Director is reminded any structural changes to the center or additions to the child care facility must be reported to Community Care Licensing. Director was reminded of Departments inspection authority, with our without any notice.

Director is reminded that ALL Staff must be fingerprint cleared prior to being in the presence of children in care, or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Director was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.



For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
LIC809 (FAS) - (06/04)
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