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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419473
Report Date: 12/07/2022
Date Signed: 12/07/2022 02:24:53 PM


Document Has Been Signed on 12/07/2022 02:24 PM - It Cannot Be Edited

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: 11DATE:
12/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Marissa VeraTIME COMPLETED:
02:45 PM
NARRATIVE
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On Wednesday, December 7, 2022 at 2 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted an Unannounced Case Management Visit. LPA met with the Director Marissa Vera and explained this visit is the Lead Testing of Water in Licensed Child Care Centers. Present on this visit were 3 staff and 11 preschool children. The facility operates from Monday to Friday from 7am to 6pm.

LPA discussed to the Director that Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer procedures for lead testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act.

Sample ID 013419473 A - Location Kitchen Faucet had a Lead Action Level of Exceedance Response. On 09/27/22 Sample Date, 09/30/2022 Analysis Date, 10/13/2022 Replaced, 11/08/2022 Second Sample Date, 11/22/2022 Analysis Date - Passed.
Sample ID 013419473 C - Location Classroom Faucet - permanently closed (unoperable) on 10/13/2022.

LPA confirmed the Plan of Correction to the Director.

This facility is being given a Type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds. Please see LIC 809D page for the citation. LPA generated a Proof of Correction Clearance Letter and provided a copy to the Director.

Exit interview was conducted with the Director Marissa Vera.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
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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Document Has Been Signed on 12/07/2022 02:24 PM - It Cannot Be Edited

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: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited

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California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds - The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.



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Sample ID 013419473 A had a Lead Action Level of Exceedance Response (Kitchen Faucset)of more than 5.5ppb. This poses a potential health, safety and personal rights risk to children in care.
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Sample ID 013419473 C - Location Classroom Faucet - permanently closed (unoperable) on 10/13/2022.

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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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2