380501237-12-15-2022-05-CC-WLYY-CM5VG2-20221215152450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380501237
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:25:03 PM

Document Has Been Signed on 12/15/2022 03:25 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CORNERSTONE ACADEMY		FACILITY NUMBER:	380501237
ADMINISTRATOR:	CHENG, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	1925 LAWTON STREET		TELEPHONE:	(415) 665-9747
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY:	44	CENSUS: 18	DATE:	12/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Christina Eng		TIME COMPLETED:	03:00 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 December 15, 2022, at approximately 12:30pm, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Required - 1 Year Visit at and met with Site Supervisor Christina Eng during the visit. Purpose of the inspection was explained. There are 18 children 3 staff members present during the visit. Teacher to child ratios were met on this day. Early Childhood Director Elizabeth Cheng arrived at facility thirty minutes into the inspection. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The center uses a clipboard for parents to sign their children in and out of the facility. LPA and Site Supervisor inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Site Supervisor, there are no firearms or weapons in the center. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in cabinet inaccessible to children. LPA reviewed medication procedures with staff. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The center provides breakfast, morning snack, lunch and afternoon snacks. Meals are prepared off site. Drinking water is provided with filter water and disposable cups. Last Emergency Drill was conducted on 12/15/2022 and properly logged. A random sample of children's fiels were reviewed today. Base on file review and review of medication, one child's Epi Pen Jr. has been expired. Another child's has nut allergy and has been prescribed Epi Pen Jr. but do not have an Epinephrine on site. Children with allergies do no have prescribe medication on site poses a health and safety risks to children in care. Type B violation is being cited today in accordance with the California Code of Regulations, Title 22, see LIC 809D. During today's visit, LPA also review staff files. Staff files are complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location. CONTINUED>>>

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CORNERSTONE ACADEMY	FACILITY NUMBER: 380501237
	VISIT DATE: 12/15/2022

NARRATIVE

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This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

Director was also advised to reach out to San Bruno Regional Office for concern or questions. Desk Duty is available M-F, 8a.m.-5p.m. (650) 266-8800. Website for forms and regulations updates: www.cdss.cs.gov/inforesources/Community-Care-Licensing

An exit interview was conducted with the Director and Plans of Corrections (POC) were developed and reviewed with Director. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of these reports

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/15/2022 03:25 PM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CORNERSTONE ACADEMY	FACILITY NUMBER: 380501237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and medication review the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. One child Epi Pen Jr. has been expired. Another child has been prescribed Epi Pen Jr. but does not have Epi Pen Jr. on site.
	POC Due Date: 12/29/2022
	Plan of Correction
1 2 3 4	Facility representatives must obtain prescribed medication from authorize representative and have it on site in case of emergency. Facility representative will send proof of medication collected from parents and send a picture to LPA by 12/29/2022.

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC809 (FAS) - (06/04)

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