<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203808503
Report Date: 01/28/2020
Date Signed: 01/28/2020 12:23:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CORNERSTONE COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
203808503
ADMINISTRATOR:THARP, CINDYFACILITY TYPE:
850
ADDRESS:208 FIG TREE ROADTELEPHONE:
(559) 665-1182
CITY:CHOWCHILLASTATE: CAZIP CODE:
93610
CAPACITY:60CENSUS: 23DATE:
01/28/2020
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Cindy Tharp - DirectorTIME COMPLETED:
12:45 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 1/28/2020, Licensing Program Analyst (LPA) Joseph Pacheco arrived at the facility to conduct a Case Management - Annual Continuation inspection. This report is a continuation of the annual/random inspection conducted on 1/21/2020. LPA met with Director, Cindy Tharp and a census was taken. LPA reviewed the facilities fire drill log and staff files that were unavailable for review during the annual inspection. A review of the facility records show that this facility is conducting a fire drill and documenting the date and time at least once every six months as required. LPA confirmed that CPR certification for staff is current and expires 8/24/2021. A review of staff records show that AB 1207 Mandated Reporter has not been completed as required.

Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS are not currently being provided. When any IMS is provided, a 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



LPA provided Director with information regarding providing incidental medical services to children, the CDSS Provider Information Notices (PINs) communication system, information on how to complete AB 1207 Mandated Reporter training and some important resources and information links offered on the CDSS website. Lead safety information was provided in accordance with AB 2370, Chapter 676, Statues of 2018.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies were cited (see LIC809-D):

CONTINUED ON LIC809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CORNERSTONE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 203808503
VISIT DATE: 01/28/2020
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
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

A copy of LIC 9224 was given to Director. Exit interview was conducted with Director.

Civil Penalties in the amount of $1,000.00 are being assessed today for having two employees working in the facility who are not fingerprint cleared.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CORNERSTONE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 203808503
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2020
Section Cited

1
2
3
4
5
6
7
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training…and shall complete renewal mandated reporter training every two years following the date on which
8
9
10
11
12
13
14
he or she completed the initial mandated reporter training. This requirement was not met as evidenced by LPA observation. Director stated that staff have not completed the required AB 1207 training. This is a potential risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14
Type B
02/14/2020
Section Cited

1
2
3
4
5
6
7
Employees...at day care center; immunization requirements. Commencing September 1, 2016, a person shall not be employed...at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between
8
9
10
11
12
13
14
August 1 and December 1 of each year. This requirement was not met as evidenced by LPA observation of staff files that did not contain documentation of required immunizations or statement that the flu shot was declined. This is a potential risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14
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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CORNERSTONE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 203808503
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2020
Section Cited

1
2
3
4
5
6
7
Personnel Requirements. (g) All personnel...shall be in good health and shall be physically and mentally capable of performing assigned tasks. (1) Except as specified in (3) below, good physical health shall be verified by a health screening…performed by or under the supervision of a physician not more than one
8
9
10
11
12
13
14
year prior to or seven days after employment or licensure. This requirement was not met as evidenced by LPA observation of a staff files that did not contain a LIC 503. This is a potential risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14
Type B
02/14/2020
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance. All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement was not met as evidenced by LPA observation of staff files that did not contain a LIC 508.
8
9
10
11
12
13
14
This is a potential risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14
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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CORNERSTONE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 203808503
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f).
8
9
10
11
12
13
14
This requirement was not met as evidenced by LPA observation of Licensing Information System which showed Staff #3 and #4 fingerprint cleared but not associated to the facility. This is a potential risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CORNERSTONE COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 203808503
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2020
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
8
9
10
11
12
13
14
This requirement was not met as evidenced by LPA observation of Licensing Information System which showed Staff #1 and #2 not fingerprint cleared. This is an immediate risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6