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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330909158
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:02:58 AM

Document Has Been Signed on 05/10/2022 11:02 AM - 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BUNDY CANYON CHRISTIAN SCHOOLFACILITY NUMBER:
330909158
ADMINISTRATOR:PHYLLIS WALKERFACILITY TYPE:
850
ADDRESS:23411 BUNDY CANYON ROADTELEPHONE:
(951) 674-1254
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY: 60TOTAL ENROLLED CHILDREN: 64CENSUS: 29DATE:
05/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Phillip WalkerTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA Alaina Wilburn conducted an unannounced case management visit. LPA met with Principal Phillip Walker. While doing a separate complaint visit, LPA observed the Director and Assistant Directors to not be active at the facility.

The licensee was asked to update the following documents, and submit to licensing within 30 days:

1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

See LIC809-D for cited deficiencies

An exit interview was conducted, and this report was reviewed with the Principal Phillip Walker. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Alaina Wilburn
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2022
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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Document Has Been Signed on 05/10/2022 11:02 AM - It Cannot Be Edited


Created By: Alaina Wilburn On 05/10/2022 at 10:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BUNDY CANYON CHRISTIAN SCHOOL
FACILITY NUMBER: 330909158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2022
Section Cited
CCR
101215.1

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Child Care Center Directors Qualifications and Duties (b) All child care centers shall have a director. (c) The child care center director shall be responsible for the operation of the center, for compliance with regulations, and for communications with the Department... correct deficiencies that constitute immediate threats to children's health and safety.
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Licensee will submit a plan on who will be the Center Director and submit a packet with all required documentation to LPA by POC date of 06/10/2022.
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The requirement is not met as evidenced by

The Director has not been actively present and the substitute has been gone for two months. The current substitute is not fully qualified, which poses a potential health and safety hazard.
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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.
SUPERVISOR'S NAME:Stephanie Hudak
LICENSING EVALUATOR NAME:Alaina Wilburn
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022


LIC809 (FAS) - (06/04)
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