197750129-10-19-2023-12-CC-JDMO-CWS2C6-20231019171612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750129
Report Date: 10/19/2023
Date Signed: 10/19/2023 05:16:33 PM

Document Has Been Signed on 10/19/2023 05:16 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	PURE & SIMPLE ACADEMY INC		FACILITY NUMBER:	197750129
ADMINISTRATOR:	SANDRA LONA AGUIRRE		FACILITY TYPE:	850
ADDRESS:	43301 DIVISION ST, SUITE 101		TELEPHONE:	(661) 524-1042
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 29	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Sandra Lona Aguirre		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/19/2023, at 9:30 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo met with the facility Director, Sandra Lona Aguirre to conduct an unannounced One Year Required inspection for the Preschool license in accordance with the facility sketch. A tour of the facility was conducted. LPA observed a total of 29 preschool children for the five classrooms (105B, 2, 3, and 4) with 6 teachers and 3 aides providing supervision. The hours of operation are 5:00 A.M. - 10:30 P.M. Monday - Friday. Incidental Medical Services (IMS) was discussed. Indoor/Children’s Area: Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, ramps, and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean, cleaning compounds are inaccessible, poisons are locked, furniture/equipment is in good condition and is free of flies, other insects, and rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual or portable storage space (cubby, individually labelled with name) for his/her clothing, personal belongings, and or bedding (stored separately). There is a working telephone. Electrical outlets are inaccessible and has plastic covers. Recalled and or prohibited toys or sleep/play equipment were not observed on the premises. There are no window cords accessible to children. Trash bins for solid waste have tight fitting lids. Drinking water is provided in every classroom and is stored in a small water pitcher. Water dispensers and water fountains are available in the facility. Children bring their own bottle/container when drinking. LPA observed a sufficient quantity of cots available for preschool children. All materials and surfaces are toxic free and are inaccessible. There is no fireplace in the facility. The center has an internal pull-down fire alarm system and fire extinguishers with a 2-A:10-B:C classification (last service date was 02/23/2022, reading in green, checked at 1:01 P.M.). Carbon monoxide devices are in operable condition (checked at 1:25 P.M.).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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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Document Has Been Signed on 10/19/2023 05:16 PM - It Cannot Be Edited

Created By: Joselito DelMundo On 10/19/2023 at 04:46 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 INC	FACILITY NUMBER: 197750129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the facility did not comply with the section cited above in that the staff #2 did not have a current mandated reporter training which posed a potential Health, Safety or Personal Rights risk to persons in care.
	POC Due Date: 11/03/2023
	Plan of Correction
1 2 3 4	Director/staff #2 will email a copy of her mandated reporter training certificate to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Lady King

LICENSING EVALUATOR NAME:

Joselito DelMundo

LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: 10/19/2023

NARRATIVE

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Restrooms: LPA inspected and observed a total 3 toilets, 5 sinks, and 2 urinals in the preschool bathrooms 1, 2, and 3. The LPA observed liquid soap, toilet paper, and trash bins with covers, were readily available. Water temperature is appropriate.

There is an isolation area for children who become ill while in care and is located in the main office. The facility maintains a comfortable temperature at all times, first aid supplies (first aid manual/guide, bandages, scissors, tweezers, antiseptics, gauze), electronic sign in/out sheets are available and completed daily. Smoking is prohibited on the premises, daily inspection for illness, no prohibited child care items observed. Firearms/weapons are not allowed or stored on premises. There is no body of water on the premises.

Napping: LPA observed children's personal blankets in each cubby. The facility provides the sheets for children in care. Mats are used and maintained in good condition, wiped/cleaned/disinfected daily, or when soiled and there is no contact with other children bedding.

Outdoor: The facility has a playground area for the preschool children. The preschool and school age children share the same playground area and is scheduled at different time. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. The area was observed to be free of debris, free from hazard, holes, broken items, debris. The slides have rubberized cushioning materials. No bodies of water were observed. According to the director, drinking water is provided during outdoor plays. Staff bring a water pitcher when they play outside, or children can go to room 108 (adjacent to the playground areas) which has two water fountains.

Teacher child ratios were observed, and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.

Health Related Services: According to Director Deborah Castillo, they were providing medications to children in care. LPA observed the facility has LIC9221 Parent Consent for Administration of Medications and Medication Chart.

Children are inspected for illnesses (wellness policy) as they arrive. Children were check with regards to their body temperature.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: 10/19/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Food Service: There is a clean microwave, refrigerators, and freezers available in the facility. The facility provides one hot lunch that is precooked for children. Children bring their own snacks.

Staff/Personnel Records: Director (qualified) qualifications were verified, Designation of Responsibility observed, immunization's, TB clearance for staff, health screening, criminal record statement, statement acknowledging suspected child abuse and mandated reporter were observed in file.

Facility Records: Roster, fire/disaster drills log was last completed on 10/11/2023 at 2:54 P.M. During this inspection, a fire/disaster drill was conducted at 1:58 P.M. LPA observed staffs and children participated in the fire/disaster drill. The facility is using an emergency alarm system with voice activation and is room 2. Maintenance personnel and other staff check each room to make sure that no one is left behind. CPR/First Aid and mandated report trainings were reviewed. Staff #2 does not have an updated mandated reporter training. Staff # 2 is advised to take the online mandated reporter training at www.mandatedreporterca.com.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394), emergency disaster plan, earthquake preparedness checklist.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. CPR/First Aid trainings were completed on different dates, 08/12/2023 and 08/13/2023. Staff # 1 completed her Mandated Reporter Training on 02/22/2023. However, staff # 2 does not have a current mandated reporter training.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: 10/19/2023

NARRATIVE

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Sign in and out sheets were reviewed. The facility is using electronic sign in and out sheet. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current.

Director was advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of a day care center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the day care center, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Type B deficiency was cited during this inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 A.M. -5 P.M.

Exit interview conducted and a copy of this report, Notice of Site Visit, and appeal rights were provide to Director Sandra Lona Aguirre.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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