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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197750130
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:52:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2024 and conducted by Evaluator Joselito DelMundo
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20241125091023
FACILITY NAME:PURE & SIMPLE ACADEMY INC.FACILITY NUMBER:
197750130
ADMINISTRATOR:SANDRA LONA AGUIRREFACILITY TYPE:
830
ADDRESS:43301 DIVISION ST. SUITE 101TELEPHONE:
(661) 524-1042
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:58CENSUS: 15DATE:
01/08/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Directors Jovita Herrera and Deborah CastilloTIME COMPLETED:
10:29 AM
ALLEGATION(S):
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Allegation: Staff did not properly report an incident involving daycare children
INVESTIGATION FINDINGS:
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This is an amended report on the report issued today, January 8, 2025.

On January 8, 2025, at 9:10 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a follow up complaint inspection to Pure & Simple Academy. The purpose of the inspection was to deliver the findings for the above complaint allegations. Upon arrival, LPA met with the directors, Jovita Herrera and Deborah Castillo, and was granted access to the facility. LPA observed 15 children in total (Rooms 301, 302, 303, and 304) with 4 staff providing care supervision.

The investigation consisted of interviews with the director, staff, parents, and a review of relevant documents.
On November 25, 2024, the Department received an allegation stating that staff did not properly report an incident involving day care children. On October 23, 2024, the Department received an incident report regarding an outbreak that the facility became aware of on October 13, 2024. The report revealed that the
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 12-CC-20241125091023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 197750130
VISIT DATE: 01/08/2025
NARRATIVE
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Pg 2

onset of the outbreak was determined to be four to seven days after the child’s exposure to the disease. However, the center failed to the report the incident to the department within 24 hours of the incident and a written report was not received within 7 days following the incident.

Based on a review of the records, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations Title 22, Division 12, Chapter 1, regulation 101212 Reporting Requirements is being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to the director, Deborah Castillo along with Notice of Site Visit and Appeal Rights.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Citations on this Visit Report are Under Appeal!

Control Number 12-CC-20241125091023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 197750130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
01/22/2025
Section Cited
CCR
101212
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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (E) Epidemic outbreaks.
This requirement is not met as evidence by:
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Staff will undergo retraining on the submission of incident reports and will provide a copy of the attendance sheet for staff training.
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Based on record review, the facility did not comply with the section cited above by failing to provide a timely incident report which posed a potential Health, Safety or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5