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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600217
Report Date: 09/19/2022
Date Signed: 09/19/2022 11:22:56 AM


Document Has Been Signed on 09/19/2022 11:22 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CORNERSTONE CHRISTIAN PRESCHOOLFACILITY NUMBER:
300600217
ADMINISTRATOR:ROBYN DELGADOFACILITY TYPE:
850
ADDRESS:17575 EUCLID STREETTELEPHONE:
(714) 962-5414
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:84CENSUS: 27DATE:
09/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Robyn DelgadoTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Romy Castanon conducted an unannounced Case Management visit. LPA met with Director, Robyn Delgado to discuss the Lead Sampling Testing conducted on 8/18/22. Director was advised on 09/14/22 that the Lead Sample Report was to be posted. Director emailed LPA all documentation requested regarding Lead. LPA confirmed that Director had posted the Lead Sample Report during visit.

LPA observed outlet D was located in Room 2, between two restrooms. Director confirmed that the outlet is still in the process of being flushed. AAA Water Co. will be returning on 09/28/22 to retest. LPA informed Director that outlet needed to be covered and inoperable outside of flushing time. During visit, LPA observed Director covered outlet with a large zip lock bag and a rubber band. Facility provides water from sinks that do not exceed lead levels in pitchers or dispensers. Children are also allowed to bring their own water bottles.

Based on LPA's record reviews the following violation was observed and is being cited in accordance with
California Code of Regulations Title 22, Division 12, Chapter 1, Subchaper 5 Section 101700.3(b)(1) California Lead Action Level at Child Cares on the attached LIC 809D.

Exit interview conducted and report was reviewed with the facility representative Robyn Delgado. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M CastanonTELEPHONE: (714) 746-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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 09/19/2022 11:22 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CORNERSTONE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300600217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2022
Section Cited

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level.
(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

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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: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M CastanonTELEPHONE: (714) 746-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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