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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750130
Report Date: 04/12/2022
Date Signed: 05/09/2022 12:49:05 PM

Document Has Been Signed on 05/09/2022 12:49 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
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: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 11DATE:
04/12/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:41 PM
MET WITH:Applicant, Lona AguirreTIME COMPLETED:
04:32 PM
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Licensing Program Analyst (LPA) Maddox, met with Director, Debbie and Applicant Lona Aguirre today to review the request for a capacity increase and provided consultation of the Regulations. During this inspection, the facility sketch was reviewed, and the center was toured in it's entirety.

As a result of this inspection, the following changes will take place for the Infant/Toddler option:

Infant Room #1 has a capacity of 15
Room #301 has a capacity of 15 Infants
Room #303 has a capacity of 14 Toddlers
Room 304 has a capacity for 14 Toddlers
Total Capacity for Infant/Toddlers will be 58 (30 Infants an 28 Toddlers)
The Infant Rooms have changing tables with sinks in arms reach.
Room #306 is designated as a Multi-purpose room and can accommodate
Rooms #303 and #304 are designated for Toddlers, each room has 1 bathroom, each bathroom has 1T/1S for a capacity of 30
Rm# 306 = 69L X 29W = 2,001/35 = 57
OUTDOORS:
56L X 19W = 1,064/75 = 15 (large area)
42L X 23W = 966/75 = 13 (smaller area)
Total outdoor space for Infant/Toddlers = 28
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 INC.
FACILITY NUMBER: 197750130
VISIT DATE: 04/12/2022
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OUTDOOR ACTIVITY SPACE:
The outdoor play area is surrounded by fencing. The play yard has natural shade and additional shade provided by the covered walkway. Applicant has installed new rubber matting on the Infant/Toddler play yard.

LPA inspected the Fire extinguishers throughout the center, last service date was 11/21, all were in the "green"; LPA observed working Smoke detectors and Fire Alarm system (hard wired) and separate Carbon monoxide detectors; Applicant was informed to conduct and maintain Fire/Earthquake drill logs. The facility will be using electronic sign in and sign out system. LPA explained that a backup system must be in place if the electronic system is not available.

Children that require IMS will have their medications administered by the director and assistance director. This facility has a IMS plan for EpiPen, Nebulizer, and Inhaler. This facility will provide Incidental Medical Services – IMS as specified in their Parent Handbook. 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/childquanda.htm

Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624.



rview was conducted, report was read and a copy was given to the applicant.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PURE & SIMPLE ACADEMY INC.
FACILITY NUMBER: 197750130
VISIT DATE: 04/12/2022
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Applicant was reminded to access the licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes and the Quarterly Updates.

Applicant was reminded that capacity and ratio must comply with specified regulations. LPA informed Applicant that current staff can be re-associated to the new facility # through Guardian.

Applicant is requesting a capacity of 58 Infant/Toddlers, when fire clearance is received, and fingerprints transferred, center will be re-licensed. Exit interview conducted, copy of report read and copy given to Applicant.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
LIC809 (FAS) - (06/04)
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