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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750079
Report Date: 04/19/2022
Date Signed: 04/19/2022 01:15:26 PM

Document Has Been Signed on 04/19/2022 01:15 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: 30CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Deborah Castillo, DirectorTIME COMPLETED:
01:20 PM
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On 04/19/22, Licensing Program Analyst’s (LPA’s) Justeene Tamayo and Justin Dorsey arrived at the facility to conduct a Case Management visit. The purpose of the case management visit was to follow-up on a self-reported Unusual Incident Report submitted by the facility on 04/13/22.

During the visit, LPA’s met with Director Deborah Castillo to discuss the reported incident that happened on 04/12/22. LPA’s toured the facility and took a census of the children present. The incident report indicated, Volunteer 1 was upset with an evaluation Staff 2 completed about Volunteer 1. Volunteer 1 confronted Staff 2. Volunteer 1 raised voice and was rude and disrespectful to Staff 2. Staff 3 stepped in and asked Volunteer 1 to leave the facility because of Volunteer 1 behavior. During the visit, LPA’s interviewed the staff members involved.

Owner Sandra Lona Aguirre requested copies of the interviews of staff members. LPA's advised owner the interviews are confidential and cannot be provided. LPA's requested Volunteer 1 evaluation report, per Owner she did not want to give the documents because they are confidential. During the visit LPA's received Volunteer 1 contact information from owner. At this time further follow up is needed.

An exit interview was conducted, a notice of site visit given and must be posted for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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