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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005435
Report Date: 04/12/2022
Date Signed: 04/12/2022 12:12:05 PM


Document Has Been Signed on 04/12/2022 12:12 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CORNERSTONE HOMESFACILITY NUMBER:
306005435
ADMINISTRATOR:DELA CRUZ, ERLINDAFACILITY TYPE:
740
ADDRESS:27052 LOST COLT DRIVETELEPHONE:
(949) 360-1379
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 6DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Joseph Sathers, AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by Joseph Sather, Administrator. LPA explained the nature of the visit to Administrator.

LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. There are six residents in care and there are no active covid-19 cases in the facility. LPA observed residents in their bedrooms and all residents appeared to be well taken care of. LPA observed required department posting, covid-19 precautionary posting in the facility. Emergency disaster and evacuation plan was observed to be posted. LPA observed a check in station in the entry of the facility. Restrooms inspected and observed to have a supply of soap and appeared to be clean. LPA inspected residents’ bedroom and they appeared to be clean and sanitary. All bedrooms observed to have all required components. Facility has a backup emergency food supply as well as water supply. PPE was observed to be stored in hallway storage. LPA toured the outside of the facility and observed a seating areas for resident’s enjoyment. The facility has completed the LIC808 Mitigation Plan, LPA reviewed and approved the plan on today’s visit. LPA emailed the signed and approved plan to the Administrator for their records.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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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