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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819356
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:08:57 PM

Document Has Been Signed on 03/06/2024 04:08 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CROSSROADS CHRISTIAN PRESCHOOLFACILITY NUMBER:
334819356
ADMINISTRATOR:MORRISON, PENNYFACILITY TYPE:
850
ADDRESS:2380 FULLERTON AVENUETELEPHONE:
(951) 278-3196
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 252TOTAL ENROLLED CHILDREN: 252CENSUS: DATE:
03/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:18 PM
MET WITH:Penny Morrison, DirectorTIME COMPLETED:
04:20 PM
NARRATIVE
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On 3/6/2024, LPA Claudia Caywood conducted a 3-year required inspection. Due to technical difficulties, LPA C. Caywood created a second annual continuation report to create a 809-D page with Health and Safety Deficiencies and Plan of Correction.

Exit interview conducted and report was reviewed with the Site Director, Penny Morrsion. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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 03/06/2024 04:08 PM - It Cannot Be Edited


Created By: Claudia Caywood On 03/06/2024 at 03:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CROSSROADS CHRISTIAN PRESCHOOL
FACILITY NUMBER: 334819356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that a staff listed on the record review did not have a Pertussis immunization for the department to review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2024
Plan of Correction
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Licensee agreed to provide proof of Pertussis immunization for the staff missing on the file review to the department by the POC due date of 3/15/2024
Type B
Section Cited
HSC
1597.16(a)(1)


This requirement is not met as evidenced by:

Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that they did not have the facility tested for water lead levels by the requested deadline which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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Licensee agreed to provide the department with a copy of the facility water testing results by the POC due date of 3/29/2024
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:Gilbert Sena
LICENSING EVALUATOR NAME:Claudia Caywood
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024


LIC809 (FAS) - (06/04)
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