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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376301177
Report Date: 10/02/2025
Date Signed: 10/02/2025 02:53:29 PM

Document Has Been Signed on 10/02/2025 02:53 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHRIST THE KING LUTHERAN CHURCH PRESCHOOLFACILITY NUMBER:
376301177
ADMINISTRATOR/
DIRECTOR:		HUMBLE, LAURAFACILITY TYPE:
860
ADDRESS:1620 S SATGE COACH LANETELEPHONE:
(760) 728-7908
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 34DATE:
10/02/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Laura Humble, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 10/02/2025 at 11:00 am, Licensing Program Analysts (LPA), Griselda Castellon, arrived for an announced pre-licensing corrections visit to inspect and approve the playground fencing surrounding the preschool playground. Upon arrival, LPA met with Director Laura Humble, toured the facility and playground area, and conducted a census.

Upon inspection, LPAs observed that the preschool playground is surrounded by a double chain-link fence and does not obstruct the view of the creek. The gate that required corrections is located toward the back of the preschool playground, next to the swing set. The double chain-link fence measures 5 ft tall. The chain link being added has small openings that measure approximately 1.75 inches, preventing climbing. The total height of the fence reaches 6 feet.

LPA observed that the gate swings away from the creek, self-closes, and includes a self-latching mechanism located six inches from the top. The latch engages automatically and does not catch or stick when closing. Photos and video documentation were taken during the visit.

Additionally, the gate is secured with a padlock to prevent access to children or staff. The only entry access to the preschool playground is near the toddler playground and is accessible through this gate.

Lastly, the gate features a padlock to prevent unauthorized access by children and staff. The only entrance to the preschool playground is located near the toddler playground, and a second entrance in the preschool playground, adjacent to the toddler playground, is accessible through the gate.

NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Griselda Castellon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHRIST THE KING LUTHERAN CHURCH PRESCHOOL
FACILITY NUMBER: 376301177
VISIT DATE: 10/02/2025
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LPA observed children and staff transitioning to the preschool playground. Two teachers and six children walked across the bridge holding a rope. While they walked crossed, a second group, two staff and twelve children, walked along the side of the playground toward the third gate. They passed the gate and crossed a second bridge, with one staff in the front holding the rope, twelve children in the middle, and the second staff at the end, also holding the rope.

LPA observed that the bridge did not have ralings and noted this was the first time it had been seen in use. LPA informed Laura that if staff plan to use the bridge, a waiver would be required. Laura explained that the bridge is not typically used and that it would be removed. By the end of the visit, LPA observed staff removing the bridge. Photos and documentation were taken during the visit.

An exit interview was conducted, and the report was reviewed with Laura Humble.

NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Griselda Castellon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC809 (FAS) - (06/04)
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