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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330911138
Report Date: 02/26/2025
Date Signed: 02/26/2025 04:45:29 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2025 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20250210120710
FACILITY NAME:IMMANUEL LUTHERAN PRESCHOOLFACILITY NUMBER:
330911138
ADMINISTRATOR:TRONA SALGADOFACILITY TYPE:
850
ADDRESS:5455 ALESSANDRO BLVD.TELEPHONE:
(951) 682-4211
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:87CENSUS: 56DATE:
02/26/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Angie Knapp and Jean KempeTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido conducted a subsequent complaint investigation to deliver final findings. An initial visit was conducted on 02/14/2025, at which time LPA conducted interviews and reviewed records. LPA met with facility representatives, Angie Knapp and Jean Kempe, toured facility, and took a census.
During the investigation, LPA interviewed all pertinent parties, including facility staff, and reviewed records.

It was alleged facility operates out of ratio. Pertinent party interviews stated teachers have operated out of ratio in the mornings. Interviews disclosed that loss of regular aides; late arrival of staff, staff absences, and initial consolidation of classes contribute to operating out of ratio. Interviews stated that operating out of ratio is not daily but occurs weekly, and usually occurs when several children arrive early at the same time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 09-CC-20250210120710
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: IMMANUEL LUTHERAN PRESCHOOL
FACILITY NUMBER: 330911138
VISIT DATE: 02/26/2025
NARRATIVE
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**This is an amended page**
Based on information gathered from interviews and staff's own admission the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, CCR 101216.3(a) is being cited on the attached LIC9099D.
Appeal rights issued and discussed with facility representatives and their signature on this form acknowledges receipt of these rights.
An exit interview was conducted and a copy of this report and notice of site visit were provided to facility representatives, Angie Knapp, and Jean Kempe. A copy of this report must be made available to the public upon request for three years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20250210120710
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: IMMANUEL LUTHERAN PRESCHOOL
FACILITY NUMBER: 330911138
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2025
Section Cited
CCR
101216.3(a)
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101216.3(a) Teacher-Child Ratio-
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement was not met as evidenced by:
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Facility will submit proof of staff AM and PM coverage for all classrooms, including a written plan of action fo covering staff shortages to the department by POC due date 03/03/25.
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 Based on information gathered from interviews and staff's own admissions the facility did not did not comply with the section cited above for ensuring teacher staff ratio. This is a potential health and safety risk to children in care. *amended citation number
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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.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5