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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270573
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:57:19 PM

Document Has Been Signed on 02/27/2024 03:57 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CORNERSTONE CHRISTIAN PRESCHOOLFACILITY NUMBER:
304270573
ADMINISTRATOR:DELGADO, ROBYNFACILITY TYPE:
840
ADDRESS:17575 EUCLID AVE.TELEPHONE:
(714) 962-5414
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 14DATE:
02/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Director, Robyn DelgadoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 02/21/2024. LPA met with the Director, Robyn Delgado. LPA observed 14 school-age children with 2 staff members in the big playground. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 02/22/2024 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a Child #2 (C2) was on top of Child #1 (C1) during outside time.

During the inspection, LPA interviewed Staff #2 (S2) and received a statement from Staff #1 (S1), as well as inspected the outdoor play structure where the incident had occurred. S1 noticed C2 was on top of C1, behind the play house at the right corner of the field. S1 immediately ran over and said "please get off of each other". S2 stated all staff were made aware of the incident and providing closer supervision for (C1) and (C2).

Based on LPA’s interview conducted, statement received from staff and playground inspected, no deficiency was observed in accordance with California Code of Regulations.

Exit interview was conducted. The Notice of Site Visit was posted. Director, Robyn Delgado was advised the Notice of Site Visit must be posted for 30 days or $100 Civil Penalty will be assessed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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