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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415051
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:10:06 PM


Document Has Been Signed on 06/27/2024 03:10 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BUCKNER EDUCATIONAL CHRISTIAN ACADEMYFACILITY NUMBER:
197415051
ADMINISTRATOR:LESLIE BUCKNERFACILITY TYPE:
830
ADDRESS:2330 W. FLORENCE AVENUETELEPHONE:
(323) 789-6154
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:16CENSUS: 3DATE:
06/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Leslie BucknerTIME COMPLETED:
09:20 AM
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On 6/27/24 at 8:02, Licensing Program Analyst (LPA) Jeanine Lipsey conducted an unannounced case management visit for the purpose of obtaining signatures and delivering an amended report. LPA met with, Director Leslie Buckner.

Upon entry, LPA Lipsey observed 3 children, being supervised by 1 staff member.



Exit interview conducted and report was reviewed with the Director Leslie Buckner. A notice of site visit was given to the director and must remain posted for 30 days.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Jeanine LipseyTELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
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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