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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419473
Report Date: 08/06/2021
Date Signed: 08/06/2021 04:59:53 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: 7DATE:
08/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Rosalie CorsiTIME COMPLETED:
05:10 PM
NARRATIVE
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On 8/6/2021 at 2:55pm, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA met with Rosalie Corsi, who is Director qualified. Present for this inspection are two staff members, including one which is not fingerprint cleared and associated and seven children in care. Facility operating hours are 7am-6pm M-F. The facility was toured to conduct a Health and Safety Inspection.

At 2:57pm, LPA toured the facility classrooms and bathrooms. The classrooms are tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classrooms. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Toilets and sinks were found to be in operable condition. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection.

At 3:15, LPA toured the kitchen/food preparation area. The kitchen is free of litter, garbage, and evidence of rodents or other vermin during this inspection. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children inside the facility.

At 3:19pm, LPA toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. Areas around slides, and high climbing equipment have cushioning material to absorb falls. Uncontaminated drinking water is available to children in the outdoor area. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: 08/06/2021
NARRATIVE
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At 3:25pm, LPA reviewed sign in/sign out sheet and LPA observed six signatures out of seven children present in the facility during today's inspection. One child present was observed not to have been signed in upon entry into the facility.

The facility has a fully charged 2A10BC fire extinguisher and working telephone. LPA tested carbon monoxide detectors (two) and found them to be functional. Per staff, fire alarm/smoke detector is connected to the fire department and, per staff, is serviced regularly. At least one staff member has current CPR/1st Aid certificate and all staff have Mandated Reporter Training certificates. The facility is in ratio today, with one teacher supervising no more than 12 children. Children's files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. When any changes to the IMS plan is made, an updated Plan for Providing 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.”

Director was reminded that ALL assistants, volunteers, frequent visitors, or adults present in the facility that are 18 years of age or older must be fingerprint cleared and associated to this facility 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 reminded that California Law requires licensed 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. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2021
Section Cited

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Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption.
This requirement was not met as evidenced by:
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Based on record review conducted by LPA, S1 had previously been fingerprint cleared but clearance was never associated to facility. No clearance for S1 remains in Guardian or LIS databases. LPA called RO at 3:30pm to request review of previous LIC500s, and no record of S1 was found. This poses an immediate risk to the health and safety of 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.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 08/06/2021
NARRATIVE
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One Type A deficiency is cited today and must be corrected by the due date. Upon receipt, Director shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgment form of proof of receiving this report (LIC9224). The LIC9224 must be placed in the child's file to be reviewed by a licensing representative upon request.

This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Director. LPA reminded the Director to post the Notice of Site Visit where it is clearly visible inside the facility for a period of 30 days after the date of today's inspection. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.

Exit interview was conducted.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4