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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750079
Report Date: 03/24/2022
Date Signed: 03/24/2022 02:27:58 PM

Document Has Been Signed on 03/24/2022 02:27 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, 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: 30TOTAL ENROLLED CHILDREN: 16CENSUS: 8DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Deborah Castillo TIME COMPLETED:
02:45 PM
NARRATIVE
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On March 24, 2022 Licensing Program Analysts (LPA) King met with the Director Deborah Castillo for the purpose of conducting an unannounced Required 1 Year inspection .Upon arrival LPA observed 8 school age children with 1 teacher and 1 teacher assistance providing care and supervision. The facility operates Monday through Friday from 5:00 AM to 10:30 PM.

LPA King toured and inspected the school age center with the director, which consist of 3 classrooms, office/reception, kitchen where meals and snacks are prepared. LPA observed bathrooms to be in operable order. Soap and paper towels are readily available for children to use. LPA observed a staff bathroom which is also utilize by children that become ill. LPA inspected outdoor play yards. Water pitcher are taken outside for children use and a fountain is available near outside play area in the indoor play room.

Furniture and equipment were inspected for age appropriateness and good repair.

The kitchen is clean and free of hazardous objects. LPA observed an appropriate amount of food and snacks. Refrigerator and freezer were clean. Center post menus on parent board.

Cleaning solutions are stored in lock area away from the food prep area, which make them inaccessible to children in care.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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 03/24/2022 02:27 PM - It Cannot Be Edited


Created By: Lady King On 03/24/2022 at 01:24 PM
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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PURE & SIMPLE ACADEMY & CHILD CARE CENTER
FACILITY NUMBER: 197750079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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Director will not allow staff 2 to report to work until prints are cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Lady King
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/24/2022 02:27 PM - It Cannot Be Edited


Created By: Lady King On 03/24/2022 at 01:24 PM
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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PURE & SIMPLE ACADEMY & CHILD CARE CENTER
FACILITY NUMBER: 197750079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 1 out of [total 3 persons] files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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Director removed staff prior to LPA exit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Lady King
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022


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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PURE & SIMPLE ACADEMY & CHILD CARE CENTER
FACILITY NUMBER: 197750079
VISIT DATE: 03/24/2022
NARRATIVE
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Sign in and out sheets were reviewed and addressed. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current, last drill was conducted March 22, 2022 and are conducted every month.

Children's records and staff records were reviewed and complete. Staff have completed the mandated reporter training and director is aware the training shall take place every 2 years.

LPA observed a fully stocked first aid kit; fully charged fire extinguishers; and operable carbon monoxide detector.

The following general information was discussed during this inspection:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Center does not provide IMS at this time.

Mandated Reporter Training Requirements: ยง1596.8662 - As of January 1, 2018, child care providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. Staff was informed that they need to take mandated reporter training at www.mandatedreporterca.com

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PURE & SIMPLE ACADEMY & CHILD CARE CENTER
FACILITY NUMBER: 197750079
VISIT DATE: 03/24/2022
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Fingerprint clearances and transfers: Prior to working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state licensed facility to another using form LIC 9184

**Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report documenting a Type A Citation and sign form LIC 9224 acknowledging receipt from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

The following deficiencies was cited, see LIC 809D.

An exit interview conducted, appeal rights discussed, and a copy of this report was provided to licensee.


SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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