<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212245
Report Date: 12/07/2023
Date Signed: 12/07/2023 04:15:30 PM

Document Has Been Signed on 12/07/2023 04:15 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CORNERSTONE CHILDREN'S CENTERFACILITY NUMBER:
010212245
ADMINISTRATOR:GRAY, TARAFACILITY TYPE:
850
ADDRESS:2407 DANA STREETTELEPHONE:
(510) 280-6126
CITY:BERKELEYSTATE: CAZIP CODE:
94704
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 41DATE:
12/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jamie PeatTIME COMPLETED:
04:30 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
Licensing Program Analyst (LPA) Diana Campos conducted an unannounced case management inspection in regards to one faucet at the facility having a lead exceedance.

Facility had the water tested 10/05/2023. It was found that one faucet in the classroom 6 bathroom, identified as faucet O, had lead that exceeded the acceptable amount of lead allowed in a child care center. The faucet identified has not been used for cooking or drinking water. No other faucets tested had lead exceedance. The faucet that had lead exceedance has been replaced and the facility was advised to cease use of this faucet. The facility will have the water retested. Director agrees to notify LPA of the retest date and send LPA the results of the testing.

Notice of Site Visit was provided and must be posted for 30 days.

Report was reviewed with Program Coordinator Jamie Peat.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/07/2023 04:15 PM - It Cannot Be Edited


Created By: Diana Campos On 12/07/2023 at 03:56 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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CORNERSTONE CHILDREN'S CENTER
FACILITY NUMBER: 010212245

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
Lead Testing Written Directive
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Facility has replaced the faucet identified as faucet O and will have the water retested. Facility will submit a plan of action indicating the test date and how they will keep the faucet inoperable. Facility will forward a copy of the final report by the POC date.
8
9
10
11
12
13
14
Based on record review a faucet at the facility (identified as faucet O) used by children had a lead exceedance, which poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2