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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750130
Report Date: 07/18/2024
Date Signed: 07/18/2024 04:01:28 PM

Document Has Been Signed on 07/18/2024 04:01 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:
197750130
ADMINISTRATOR/
DIRECTOR:		SANDRA LONA AGUIRREFACILITY TYPE:
830
ADDRESS:43301 DIVISION ST. SUITE 101TELEPHONE:
(661) 524-1042
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 10DATE:
07/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:46 PM
MET WITH:Sandra Lona AguirreTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On July 18, 2024, at 11:00 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at Pure and Simple Academy Inc. LPA met with Director Sandra Lona Aguirre. LPA stated purpose of the inspection was to follow-up on a self-reported Unusual Incident Report (UIR) that happened on 07/08/2024 at the center where a child received rug burn. The investigation included an inspection of the facility where the incident occurred room, a review of facility records, and confidential interviews with staff members. LPA was provided with copies of the Children’s Attendance Sheet, Name to Face Attendance Sheet, and the Staff Attendance on the day the incident occurred.

During this visit, LPA observed ten infants with three staff members providing care and supervision in rooms 301 and 302. Based on records review, it was revealed that Jessica Reyes (Infant Teacher 1, IT1) is a fully qualified teacher.

Based on the evidence gathered, documents reviewed, and the recorded video provided, the incident happened at 4:05 P.M. while IT1 was starting to clean the classroom 301. IT1 pulled the mat and the infant (C1) got rug burn. It appeared to be that the incident was unintentional, although C1 sustained rug burn while at the facility. IT1 stated that Kamaria Purvis (Infant Teacher 2), was inside the room cleaning the diaper changing area. Therefore, teacher to child ratio was met.

LPA discovered there were personal rights concern regarding IT1 providing care and supervision while cleaning. IT1 stated that after the incident, IT1 put the infants on highchairs instead of leaving them on the mats.

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: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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: 197750130
VISIT DATE: 07/18/2024
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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.

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

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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