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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750129
Report Date: 09/19/2023
Date Signed: 09/19/2023 11:52:37 AM

Document Has Been Signed on 09/19/2023 11:52 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PURE & SIMPLE ACADEMY INCFACILITY NUMBER:
197750129
ADMINISTRATOR:SANDRA LONA AGUIRREFACILITY TYPE:
850
ADDRESS:43301 DIVISION ST, SUITE 101TELEPHONE:
(661) 524-1042
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
09/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nataly AguirreTIME COMPLETED:
11:30 AM
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On 09/19/2023, Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced case management inspection. LPA Joselito L. Del Mundo met with Human Resources Director Nataly Aguirre. The purpose of today's inspection is to conduct a case management inspection about the water lead testing results that was submitted to the Department last 08/24/2023. Based on the results, Teacher’s Lounge has a 7.00 ug/L (micrograms per liter) of lead in the water outlet at the facility. The results indicated are not measured in parts per billion (ppb). Also, the required water lead test results should not exceed 5.5 ppb.

During this inspection, HR Director Nataly Aguirre toured the LPA inside the Teacher’s Lounge where the water outlet was located. Per director Aguirre, they were using the outlet for handwashing only and not for food preparation and drinking. Pump water and water filtering machines were also observed during this inspection. Water containers are stored in the storage room adjacent to the Teacher’s Lounge.

According to HR Director Nataly Aguirre, water samples were collected on 07/31/2023 and it will take 14 days to complete the process of water lead testing.

HR Director Nataly Aguirre called the company who conducted the test to verify the results reflected on the Teacher’s Lounge do not exceed 5.5 ppb. The results were then converted to parts per billion (ppb). Based on the results submitted, it was determined that the Teacher’s Lounge has a 0.0070 ppb of lead in the water outlet, therefore the center is compliant per water lead testing that was conducted.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited at the time of inspection. HR Director Aguirre was provided a copy of the appeal rights. An exit

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PURE & SIMPLE ACADEMY INC
FACILITY NUMBER: 197750129
VISIT DATE: 09/19/2023
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at the time of inspection. HR Director Aguirre was provided a copy of the appeal rights. An exit interview was conducted with HR Director.

This report shall be made available to the public upon request. The Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
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