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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419473
Report Date: 08/11/2023
Date Signed: 08/11/2023 02:58:10 PM


Document Has Been Signed on 08/11/2023 02:58 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
OAKLAND SOUTH EAST, 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: 10DATE:
08/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Linsay Anadalis - Acting DirectorTIME COMPLETED:
03:30 PM
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 Licensing Program Analyst (LPA) Andrew Elliot met with teacher and acting director Lindsay Andalis for an unannounced Annual Random Inspection on 08/11/2023 at 11:30 am. The facility director, Marissa Vera, has been out on medical leave since 02/15/2023. Ms. Rose Corsi, a teacher who was present during the inspection, was acting director from 02/15/2023 to 07/10/2023. Ms. Anadalis has been acting director since 07/10/2023. LPA disclosed the purpose of the inspection and was granted entry into the facility by the site supervisor. In addition to the acting director, there are 10 preschool aged children and 1 additional teacher present. The facility operates Monday - Friday from 7:00 AM to 6:00 PM. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed; There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpack are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition. Areas around slides and high climbing equipment have cushioning material to absorb falls. There are separate bathrooms for children and staff. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available for children. The program provides daily snacks and children bring their own lunch. The classroom has appropriate postings. The last Emergency Drill was conducted on 08/02/2023 and is properly logged. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. There is a sandbox located on the playground with a lid to prevent debris from getting inside.

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SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew ElliottTELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CITY OF UNION CITY - HOLLY CENTER
FACILITY NUMBER: 013419473
VISIT DATE: 08/11/2023
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 LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick-up person. There is a working fire alarm system in the facility. The facility has a working smoke and carbon monoxide detector, a fully charged model 2A40BC fire extinguisher, and a working telephone available.

Five children records reviewed were complete. All children have a record of emergency identification information on file. Four staff records were reviewed and were complete. All staff has a criminal record clearance on file. The site acting director and staff has a current Pediatric First Aid/CPR certificate on file. All staff has taken Mandated Reporter training. LPA received an updated copy of the facility’s roster.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

The acting director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

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SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew ElliottTELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CITY OF UNION CITY - HOLLY CENTER
FACILITY NUMBER: 013419473
VISIT DATE: 08/11/2023
NARRATIVE
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 For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers. Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were cited as a result of today’s visit.

A notice of Site Visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with acting director Lindsay Andalis.

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SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew ElliottTELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
LIC809 (FAS) - (06/04)
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