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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806525
Report Date: 04/16/2026
Date Signed: 04/16/2026 12:20:57 PM

Document Has Been Signed on 04/16/2026 12:20 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHRIST LUTHERAN EARLY CHILDHOOD CENTERFACILITY NUMBER:
370806525
ADMINISTRATOR/
DIRECTOR:		PAYNE, MELISSAFACILITY TYPE:
850
ADDRESS:7915 LA MESA BOULEVARDTELEPHONE:
(619) 634-8822
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 57DATE:
04/16/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Melissa PayneTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 04/16/2026, Licensing Program Analyst (LPA), Dana Stevens, conducted an unannounced case management inspection to follow up on an Unusual Incident. LPA met with the Facility Director, Melissa Payne. There were 57 children with 15 staff present at the time of the inspection.

During today's visit LPA inspected the Pre-K classroom activity area and play equipment, took photos, and interviewed Director, staff and children.

On 03/23/2026 the facility self-reported an incident that occurred on Friday, 03/20/2026 at approximately 10:00 AM. During Music and Movement activities, Child 1 (C1) was balancing on "Stepping Stones" when C1 lost his balance and fell, hitting his forehead on the edge of the cubby shelves. C1 sustained an approximately 1/2 inch cut on his forehead. Center staff applied first aid and C1's parent was immediately notified of the incident. C1's parent arrived shortly after the incident and took C1 for medical care. C1 returned to school Monday, 03/23/2026 with temporary restrictions from his doctor but has since been released to full activities.

Per interviews, the staff handled the incident appropriately, applying first aid to the wound and immediately notifying C1's parent. The incident was reported timely to Licensing via an Unusual Incident Report (LIC 624). Thick, baby proofing foam tape has been appliced to all cubby edges in the Pre-K classroom activity area. LPA inspected the Pre-K classroom and the area of the incident and found no hazards. The "Stepping Stones" used during the incident are age-appropriate, for ages 3-6.

Based on observation and interviews this incident appears to be have been an accident.
No deficiencies cited.

An exit interview was conducted and a copy of the report and the Notice of Site Visit was provided to the Facility Director. Notice of Site Visit must be posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Rajani Goudreau
NAME OF LICENSING PROGRAM ANALYST: Dana Stevens
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2026
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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