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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412909
Report Date: 10/23/2024
Date Signed: 10/23/2024 11:44:17 AM


Document Has Been Signed on 10/23/2024 11:44 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CORNERSTONE PRESCHOOLFACILITY NUMBER:
197412909
ADMINISTRATOR:MELISA GIUFFRIDAFACILITY TYPE:
850
ADDRESS:5004 LEWIS ROADTELEPHONE:
(818) 991-5439
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:90CENSUS: 21DATE:
10/23/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Elizabeth DominguezTIME COMPLETED:
11:45 AM
NARRATIVE
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On 10/23/24, at 8:15 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Three Year Required inspection of the abovementioned Child Care Center (CCC). LPA met with Elizabeth Dominguez, Assistant Director of the CCC. LPA explained the purpose and nature of the inspection. LPA toured the interior and exterior of the CCC with the Assistant Director. LPA notes, the CCC's Director, Melisa Giuffrida, joined LPA and Assistant Director during the tour of the interior. The Preschool operates Monday- Friday, 8:00 AM- 5:00 PM. Currently the facility uses four classrooms for child care services; Room One- currently closed, Room 2- two years of age children, Room 3- three years of age children and Room 4- children 4 years and above. The CCC has a Toddler Option, however the CCC has no children in the Toddler component of the CCC. At the time of the inspection, LPA observed 21 children on site, along with six teachers (cleared and associated).

The CCC is clean and orderly. LPA observed required licensing forms and documents posted on the hallway walls near the entry of the CCC. LPA also observed schedules of activities and menus in the hallway area. LPA observed the CCC's Sign In/Out forms on clipboards just outside the entry door of the CCC. The forms contained the arrival and departure times of children in care and well as the signatures of the children's authorized representatives. The classrooms have age appropriate equipment and furnishings available to children in care. The classrooms also have cubbies for children to store their personnel effects. Disinfectants, cleaning solutions and sharps in each classroom are located in elevated cabinets, which are secure and inaccessible to children in care. Medication in the CCC is located in supply closet near the CCC's main office. The CCC has multiple First Aid kits on site. All of the CCC's classrooms have carbon monoxide detectors. A carbon monoxide detector in Room 2 was tested at 8:56 AM and found to be operable. The has CCC five restrooms for children in care. Four of the five restrooms are attached to the CCC's classrooms. All restrooms are observed in safe and sanitary operating condition. LPA observed a refrigerator in the CCC's kitchen area which stored food for children in care. Lunches and snacks are provided by the parents of children in care, while the CCC provides a afternoon snack. The CCC has supplemental food on site for children should the need arise. There also has available filtered drinking water for children inside and outside of the facility. Children in care also bring water from their homes for consumption (CONT. 809-C, Page 2)

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
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 10/23/2024 11:44 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CORNERSTONE PRESCHOOL
FACILITY NUMBER: 197412909

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview, the licensee did not comply with the section cited above in the Child Care Center (CCC) has not had their water sources tested for lead contamination, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2024
Plan of Correction
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Administrator to test CCC's water sources for lead contamination and provide proof of testing to CCLD (elvin.baddley@dss.ca.gov) by the close of business (5:00 PM) on later than 11/6/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CORNERSTONE PRESCHOOL
FACILITY NUMBER: 197412909
VISIT DATE: 10/23/2024
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at the CCC. At 9:45 AM, LPA was informed the CCC has not had its water sources tested for lead contamination. LPA reminded Assistant Director and Director of the obligation to have the CCC's water sources tested for lead contaminates.

The CCC outdoor playground areas are enclosed by a combination of cider block and wrought iron fencing. The fence’s entry/exit gates are secured. The surfaces of the outdoor playground areas are varied. LPA observed age appropriate play equipment in the play areas. The play equipment is free of sharp, loose or pointed objects. The play structures in the outdoor playground areas have adequate cushioning materials (i.e. sand, wood chips) to absorb falls and shade created by building overhangs, shade sails and trees. LPA reminded Assistant Director to replace outdoor play equipment and furnishings when such items begin to degrade or are not in good repair. No bodies of water are observed on site.



LPA reviewed children, staff and facility records. The children’s records sampled were complete and found to contain Parent's Right receipts, emergency contact information and immunization records, among other required licensing documentation and forms. Staff records were reviewed. Staff records sampled were complete and found to contain First Aid/CPR certifications (EMSA approved),immunization records, and educational qualifications, among other required licensing documentation and forms. LPA notes the last disaster drill at the facility occurred on 9/16/24. The CCC's also has a current roster of children in care. No firearms or ammunition are stored on site.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website (CONT. 809-C, Page 3)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CORNERSTONE PRESCHOOL
FACILITY NUMBER: 197412909
VISIT DATE: 10/23/2024
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at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility representative was reminded that all adults 18 and over, including employees and volunteers,
as specified in HSC section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A Type B Deficiency is being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and HSC(refer to LIC 809-D). Director was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Elizabeth Dominguez.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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