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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600052
Report Date: 10/09/2025
Date Signed: 10/09/2025 03:15:21 PM

Document Has Been Signed on 10/09/2025 03:15 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
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: 68CENSUS: 21DATE:
10/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:04 PM
MET WITH:Laura HumbleTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 10/09/25, Licensing Program Analysts (LPA) Kelli Waters, conducted an unannounced Case Management visit to follow up on Unusual Incident Report (UIR) that was submitted via phone to Community Care Licensing (CCLD) on 10/02/25, regarding an incident that took place on 10/02/25. LPA met with Director, Laura Humble, and informed her of the reason for the visit. LPA conducted a facility inspection, took census of the facility, reviewed records and conducted interviews.

On 10/02/25, the Director reported the following to CCLD; on 10/02/25, at 9:00 am, the facility conducted a fire drill. Upon returning to the classroom at approximately 9:07 am, staff #1 (S1) and staff #2 (S2) found a child (C1) had been left inside the classroom.

During the investigation, LPA Waters inspected the facility, conducted interviews, and reviewed records. Interviews and record review revealed that C1 was left unattended in Classroom #6 for approximately 5-7 minutes while the staff and other children were evacuating for a fire drill in the facility parking lot. According to interviews, staff became aware of C1’s absence during the drill only after they returned to the classroom. The facility is currently conducting an internal investigation to determine further action needed and will review supervision training as well as disaster drill procedures with staff.

Christ the King Lutheran Preschool is being issued a TYPE A deficiency for Responsibility for Providing Care and Supervision with an immediate $500 civil penalty assessed. See 809D and LIC421IM for details.

An exit interview was conducted, a copy of this report, and appeal rights.
Exit interview conducted and report was reviewed with the Director, Laura Humble. Appeal rights were provided, and a Notice of Site Visit was given and must be posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Kelli Waters
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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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Document Has Been Signed on 10/09/2025 03:15 PM - It Cannot Be Edited


Created By: Kelli Waters On 10/09/2025 at 02:53 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHRIST THE KING LUTHERAN PRESCHOOL
FACILITY NUMBER: 376600052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2025
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation

This requirement has not been met as ecidenced by:
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DIrector will hold a staff training on 10/13/25 regarding care and supervision and disaster drill procedures. Director will provide LPA with training materials, meeting attendance roster, and disaster plan procedures via email by 10/17/25.
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Based on interviews and record review, C1 was left unattended in a classroom for approximately 5-7 minutes, therefore the licensee did not comply with the section cited above in which posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Carlos Martinez
NAME OF LICENSING PROGRAM MANAGER:
Kelli Waters
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2025


LIC809 (FAS) - (06/04)
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