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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750129
Report Date: 02/08/2024
Date Signed: 02/14/2024 09:26:03 AM

Document Has Been Signed on 02/14/2024 09:26 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: 28DATE:
02/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Deborah CastilloTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at Pure and Simple Academy Inc. LPA met with Deborah Castillo. LPA stated purpose of the inspection was to follow-up on a self-reported Unusual Incident Report (UIR) that happened on 02/01/2024 at the center where a child was injured. The investigation included an inspection of the facility where the incident occurred, a review of facility records, and confidential interviews with staff members.

LPA observed 31 preschool children and 4 staff members providing care and supervision. Teacher to child ratio was also met.

Based on the information gathered and the recorded video provided, the incident happened at 11:51 A.M. while teacher (T1) was writing the stars (rewards) and X’s (misbehaviors) on the board. C1 tried to approach T1 and smacked the board (about 1.5m x 1m) using his right palm which led to a cut. Afterwards, C1 received first aid medications and parent was notified. LPA observed that the reward board was taken out of the classroom.

The interview conducted with staff revealed that classroom 1 is using a different reward system. Children who behave got stars as rewards and X for misbehavior. Based on the photos provided during the incident, C1 is not the only child who got X marks. LPA advised staff that this reward system may lead to personal rights violation.

Based on the evidence gathered, no deficiencies were cited as a result of this self-reported unusual incident report.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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: 02/08/2024
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Pg 2

A LIC 9213 Notice of Site Visit was left at facility and must be posted for 30 days. Failure to do so will result in an immediate civil penalty assessment of $100.00.

This is an amended report on the report issued on 02/08/2024.

An exit interview was conducted, Appeal Rights and a copy of this report were provided to Director Deborah Castillo.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC809 (FAS) - (06/04)
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