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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750079
Report Date: 07/01/2022
Date Signed: 07/01/2022 10:45:26 AM

Document Has Been Signed on 07/01/2022 10:45 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: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 8DATE:
07/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Sandra Lona AguirreTIME COMPLETED:
10:57 AM
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On 07/01/2022, Licensing Program Analysts (LPA's) Justin Dorsey and Barbara Beneroso arrived at the facility to conclude the follow up on an unusual incident report submitted to the Department on 04/13/22.

During the visit, LPA's met with Owner Sandra Lona Aguirre . 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 her voice was rude and disrespectful to Staff 2. Staff 3 stepped in and asked Volunteer 1 to leave the facility because of Volunteer 1’s behavior.

The information obtained during the unusual incident follow up revealed no children witness or heard what occurred during the incident. Staff 3 handled the situation accordingly by asking Volunteer 1 to leave the facility to ensure the health and safety of children in care. No violations were found.

Facility is encouraged to continue to report incidents that occur in the facility.

An exit interview was conducted, a copy of this report was provided along with the notice of site visit.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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