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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750079
Report Date: 02/07/2022
Date Signed: 03/07/2022 11:13:00 AM

Document Has Been Signed on 03/07/2022 11:13 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PURE & SIMPLE ACADEMY & CHILD CARE CENTERFACILITY NUMBER:
197750079
ADMINISTRATOR:AGUIRRE, SANDRA LONAFACILITY TYPE:
840
ADDRESS:43301 DIVISION ST SUITE 101TELEPHONE:
(661) 524-1042
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
02/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Maddox, Licensing Program Manager (LPM) Bell, and Regional Manager (RM) Herring met with Director, Debbie and Licensee Mrs. Aguirre today to review the request for a capacity increase and consultation was provided. During this inspection, the facility sketch was reviewed, and the center was toured in it's entirety.

As a result for this inspection, the following changes will take place for the School age Component:
School age children will occupy Rooms A, B, and C (10 children in each room)

There are 2 bathrooms in the School age room, each bathroom has 1 toilet and 1 sink for a total capacity of 30 children. Licensee will send in a request to decrease this capacity from 60 to 30 (including a fee of $25).

Licensee will send in an updated applications for all components, updated play yard schedule, and updated facility sketch.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2022
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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