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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330911138
Report Date: 02/28/2025
Date Signed: 02/28/2025 03:00:51 PM

Document Has Been Signed on 02/28/2025 03:00 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:IMMANUEL LUTHERAN PRESCHOOLFACILITY NUMBER:
330911138
ADMINISTRATOR/
DIRECTOR:		TRONA SALGADOFACILITY TYPE:
850
ADDRESS:5455 ALESSANDRO BLVD.TELEPHONE:
(951) 682-4211
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY: 87TOTAL ENROLLED CHILDREN: 87CENSUS: 43DATE:
02/28/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Jean KempeTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On the date and time listed above, a case management visit was conducted by Licensing Program Analyst (LPA) Giselle Carbullido to deliver an amended report. During today’s visit, LPA toured the facility and census was taken, with 43 children present. LPA met with Facility Representative, Jean Kempe to deliver amended report.
Exit interview conducted and a copy of this report and notice of site visit was provided to the Facility Representative. A copy of this report must be made available to the public for 3 years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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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