566210701-10-29-2025-17-CC-FHEZ-DMWRKQ-20251029130554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566210701
Report Date: 10/29/2025
Date Signed: 10/29/2025 01:06:01 PM

Document Has Been Signed on 10/29/2025 01:06 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CORNERSTONE CHRISTIAN PRESCHOOL		FACILITY NUMBER:	566210701
ADMINISTRATOR/ DIRECTOR:	ELIZABETH LUNDBERG		FACILITY TYPE:	850
ADDRESS:	1777 ARNEILL ROAD		TELEPHONE:	(805) 987-7108
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY: 88	TOTAL ENROLLED CHILDREN: 45	CENSUS: 39	DATE:	10/29/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:16 PM
MET WITH:	Elizabeth Lundberg		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE

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On October 29, 2025 at 12:16 PM, Licensing Program Analyst (LPA) Fernando Hernandez made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPA met with Director Elizabeth Lundberg to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office by phone on 05/13/2025. LPA toured the play yard area where the incident occurred and interviewed the Director, and staff that were involved in the incident.

On 05/12/2025 an incident occurred at the center, where C1 was running around the playground structure area where he tripped. C1 fell on face first onto sliding pole and lost a tooth. S1 stated that C1 was running by himself when C1 accidentally tripped and fell face first, C1 did not cry, they immediately got back up. S1 stated that it happened so quick but following the accident parents were immediately informed. Parent arrived and took the C1 to the dentist.

The child returned to the facility approximately (2) days after the incident. Director stated staff were reminded about the importance to monitor the children To prevent any similar incidents, staff has been instructed to keep a watchful eye of the children playing in case of any similar situation were to occur.

Given the incident was observed by staff who took appropriate action by reporting to licensing, calling parent, and this being an incident that could not have been prevented by staff, no deficiencies are being cited today.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Elizabeth Lundberg.

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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