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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600052
Report Date: 10/08/2019
Date Signed: 10/08/2019 09:26:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHRIST THE KING LUTHERAN PRESCHOOLFACILITY NUMBER:
376600052
ADMINISTRATOR:COSTA, ANGELAFACILITY TYPE:
850
ADDRESS:1620 SOUTH STAGECOACHTELEPHONE:
(760) 728-7908
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:57CENSUS: 7DATE:
10/08/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
06:45 AM
MET WITH:Angela CostaTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility per a request from the facility for a capacity increase. The facility was toured inside and out, Room #4 is added to rooms #3, 4, 5, 6 and 8. The previous capacity of 57 will be changed to 68 as per the amount requested on the application, granted on the fire clearance and room measurements on this date. There is sufficient room for an additional 11 children in classroom #4.

Preschool will operate in rooms #3, 4, 5, 6 and #8.

An exit interview was conducted and a copy of this report was provided to Ms. Costa on this date.

A copy of this report must be made available to the public, upon request for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
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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