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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203808503
Report Date: 02/26/2020
Date Signed: 02/26/2020 09:35:53 AM

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: 43DATE:
02/26/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Cindy Tharp - DirectorTIME COMPLETED:
09:45 AM
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On 2/26/2020 Licensing Program Analyst (LPA), Joseph Pacheco arrived at the facility to conduct an unannounced Case Management - Plan of Correction (POC) Inspection. LPA met with Director, Cindy Tharp to review the POC’s associated to deficiencies cited on 1/28/2020: Today, LPA verified the following:

· Staff have completed AB 1207 Mandated Reporter Training.
· Staff files contain required immunization records.
· Staff files contain a completed LIC 508.
· Staff files contain health screening information.

LPA cleared deficiencies on this date and provided Director with a "Letter of Deficiency Citations Cleared." This letter must be filed in the facility for three years and upon request made accessible to the public for review.

No deficiency cited on this date.

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: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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