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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600052
Report Date: 06/12/2024
Date Signed: 06/12/2024 11:24:58 AM

Document Has Been Signed on 06/12/2024 11:24 AM - 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 PRESCHOOLFACILITY NUMBER:
376600052
ADMINISTRATOR/
DIRECTOR:		HUMBLE, LAURAFACILITY TYPE:
850
ADDRESS:1620 SOUTH STAGECOACHTELEPHONE:
(760) 728-7908
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 68TOTAL ENROLLED CHILDREN: 57CENSUS: 25DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Laura HumbleTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On date and time listed above, Licensing Program Analyst (LPA), Keely Messerschmidt, made an unannounced Case Management visit on this date to deliver an amended LIC 809D for inspection conducted on 05/23/24. LPA met with Director Laura Humble, who was informed of the reason for the premise visit.

An exit interview was conducted, and a copy of this report was provided to the Director. Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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