013419473-8-28-2024-52-CC-BPLY-D8KR6K-20240828124451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419473
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:44:56 PM

Document Has Been Signed on 08/28/2024 12:44 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 CENTER		FACILITY NUMBER:	013419473
ADMINISTRATOR/ DIRECTOR:	ANDALIS, LINDSAY		FACILITY TYPE:	850
ADDRESS:	31600 ALVARADO BLVD.		TELEPHONE:	(510) 675-5488
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY: 19	TOTAL ENROLLED CHILDREN: 19	CENSUS: 11	DATE:	08/28/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Lindsay Andalis- Director		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/28/24, Licensing Program Analyst (LPA) Briana Plumboy met with Director Lindsay Andalis for an unannounced random inspection. The center and playground were toured to conduct a Health and Safety inspection. There are 11 children present during the visit. Also present for the visit was 3 staff. This facility currently operates from 7:00am until 6:00pm, Monday through Friday. The center consists of 1 room, an adjacent napping room, and an auditorium which is 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 during today's inspection. 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 during today's inspection. 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 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 8/9/24. The center is equipped with a first aid kit, working telephone, smoke detector (monitored by the city of Union City), 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

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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 5

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: 08/28/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

All required forms are posted. Lic. 500 and facility roster was reviewed. This facility does provide incidental medical services (IMS) to the children. LPA reminded director to have all prescribed and non-prescribed medications to have original containers with unaltered labels. The center Director has LIC 9221 (Parent Consent for Administrating Medications form) on file for each child.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. The facility is following and have developed IMS plan on file. 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 adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed facility. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee 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.

See 809-D for type B citation cited during today's inspection as well as 2 technical violations cited. Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with center director, Lindsay Andalis.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 08/28/2024 12:44 PM - It Cannot Be Edited

Created By: Briana Plumboy On 08/28/2024 at 10:30 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 08/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(e)

Outdoor Activity Space

(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above due to the cushioning located underneath the play structure is cracking in multiple locations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/13/2024
	Plan of Correction
1 2 3 4	On or before 9/13/24, the Director will contact the City of Union City and develope a plan to maintain the cushioning under the play structures. The Director stated she will send LPA Plumboy a plan of action either via fax, email, or post.Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Norona

LICENSING EVALUATOR NAME:

Briana Plumboy

LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5