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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493684
Report Date: 02/18/2025
Date Signed: 02/18/2025 02:51:36 PM

Document Has Been Signed on 02/18/2025 02:51 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BUCKNER EDUCATIONAL CHRISTIAN ACADEMYFACILITY NUMBER:
197493684
ADMINISTRATOR/
DIRECTOR:		BUCKNER, LESLIEFACILITY TYPE:
850
ADDRESS:2114 W. MANCHESTER AVENUETELEPHONE:
(323) 758-8433
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 26DATE:
02/18/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
03:07 PM
NARRATIVE
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Licensing Program Analyst (LPA), Keyona Scott, conducted an unannounced 3 - Year Required Annual inspection to the Child Care Center on 02/18/2025 at 11:40 AM. LPA met with Lead Teacher (A1) at 11:52 AM. LPA was guided on a tour inside and outside of the facility. LPA observed proper teacher to children ratios. At approximately 12:05 PM, LPA observed the preschoolers preparing for lunch. LPA observed the following: 26 children sitting at tables awaiting lunch to three (3) teachers in the classroom. All Adults present, working and/or volunteering at the facility have a criminal record clearance or exemption.

This is a preschool program that serves children ages two (2) years old to six (6) years old. The preschool center operation hours are Monday through Friday 6:00 AM to 6:00 PM. Facility serves two (2) meals, breakfast and lunch and one (1) afternoon snack. LPA advised Lead Teacher to ensure children's water bottles are labeled with child's name.

PHYSICAL PLANT
All areas identified on the Facility Sketch were inspected. The preschool program consists of one (1) classroom. LPA observed the following in the classroom: cubbies with each child's name, outlet covers over the electrical outlets, napping mats, table and chair sets, kitchen play sets, blocks, dolls and other age-appropriate playthings.

The facility was kept clean, neat and orderly. LPA observed the following in the children's restroom: four (4) toilets, four (4) sinks and three potty-training chairs. LPA observed all toilets and sinks to be safe, sanitary and functional.

All poisons and hazardous items are stored and inaccessible to children in care. All floors are clean and safe. LPA observed the classroom and all kitchen areas and/or food preparation areas clean and free of litter and other hazardous items.
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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BUCKNER EDUCATIONAL CHRISTIAN ACADEMY
FACILITY NUMBER: 197493684
VISIT DATE: 02/18/2025
NARRATIVE
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Outdoor play area is located at the rear of the facility. Outdoor play equipment is in safe condition and is free of sharp, loose or pointed parts. The surface of the outdoor activity space is cushioned to absorb a fall, maintained in safe condition and is free of hazards. LPA observed age-appropriate play structures and equipment in the outdoor play area. Drinking water is readily available both indoors and outdoors.

LPA did not observe any bodies of water on the facility premises.

FACILITY RECORDS
There is at least one person present at facility that is trained in Pediatric CPR and First Aid. Per file review, LPA observed completion of Mandated Reporter training certificate in staff's files reviewed.

LPA reviewed for the following Personnel Records of two (2) staff files during today's inspection:
  • Staff Qualifications
  • Proof of immunization of measles (MMR), pertussis (Tdap) and influenza
  • Current Pediatric CPR and First Aid Certification
  • TB clearance or risk assessment
  • LIC 503 (Health Screening Report)
  • LIC 508 (Criminal Record Statement)
  • LIC 9108 (Statement Acknowledging Requirement to Report Child Abuse)
  • Mandated Reporter Training Certificate
  • LIC 9052 (Employee Rights)


LPA reviewed for the following Children's Record of six (6) children's files during today's inspection:
  • LIC 613A (Personal Rights)
  • Admission Agreement
  • LIC 700 (Identification and Emergency Information)
  • LIC 701 (Physician's Report)
  • LIC 995 (Notification of Parents' Rights)
  • LIC 627 (Consent for Emergency Medical Treatment)
  • Immunization Record
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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BUCKNER EDUCATIONAL CHRISTIAN ACADEMY
FACILITY NUMBER: 197493684
VISIT DATE: 02/18/2025
NARRATIVE
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FACILITY RECORDS (continued)
LPA observed the following posted documents during today's inspection:
  • Facility License
  • Menus
  • PUB 269 - Child Passenger Restraint System Poster
  • PUB 393 - Notification of Parents' Rights
  • LIC 610- Emergency Disaster Plan
  • LIC 613A- Personal Rights (LPA provided updated copy with correct Regional Office address)

LPA reviewed the following documents during today's inspection:
  • Verification of Disaster and Fire Drills: Per review, last fire and disaster drill was conducted on 01/28/2025.
  • Daily Activity Schedule
  • Sign In/Out Sheets
  • LIC 9148 - Earthquake Preparedness Checklist

LPA identified the following locations during today's inspection:
  • Medication Storage Area for Children Requiring Permissible Medical Services- Per Lead Teacher, there are no children currently enrolled that require permissible medical services
  • Functioning Carbon Monoxide Detector, Smoke Alarm(s) and Fire Extinguisher(s)

The facility was operating in substantial compliance during today’s inspection on 02/18/2025. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies cited.

The following was thoroughly discussed:
Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BUCKNER EDUCATIONAL CHRISTIAN ACADEMY
FACILITY NUMBER: 197493684
VISIT DATE: 02/18/2025
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The following was thoroughly discussed (continued):
LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative.
PAGE 4
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
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