197750131-5-9-2022-12-CC-DMAX-CE9R9E-20220509124924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750131
Report Date: 04/12/2022
Date Signed: 05/09/2022 12:49:31 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:	197750131
ADMINISTRATOR:	SANDRA LONA AGUIRRE		FACILITY TYPE:	840
ADDRESS:	43301 DIVISION ST. SUITE 101L		TELEPHONE:	(661) 524-1042
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	30	CENSUS: 7	DATE:	04/12/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Applicant, Lona Aguirre		TIME COMPLETED:	03:40 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	Licensing Program Analyst (LPA) Maddox, Debbie and Applicant Mrs. Aguirre today for the purpose of re-licensing Pure and Simple due to a change of ownership (The Applicant is now a Corporation). During this inspection, the facility sketch was reviewed, and the center was toured in it's entirety. Room A (2 sides): 30 X 10 = 300 sq ft 23 X 14 = 322 Total: 622/35= 18 Room B: 15 X 30 = 450/35=13 Room C (2 sides): 26 X10=260 30 X 10 = 300 Total: 560/35 =16 With indoor measurements for the School age building = 47 children Applicant also wants to include the Therapy Room (according to facility sketch) as a School age room if needed. The library can accommodate 6 children. Total Indoor Space for the School age component = 53 Bathrooms: There are 2 bathrooms inside the School Age building, each bathroom has 1T/1S for a capacity of 30

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
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: 197750131
	VISIT DATE: 04/12/2022

NARRATIVE

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The Outdoor play yard:
School age and Preschool Yard (Middle Area)
24W X 42L = 1,008/75= 13 (FT)
22W X 32L = 704/75 = 9 (BK)
Total Outdoor Space = 22
Rm# 306 = 69L X 29W = 2,001/35 = 57
OUTDOOR ACTIVITY SPACE:
The outdoor play area is surrounded by fencing. There's natural shade available on the are shaded areas including trees, chairs and canopies for shade. Applicant has installed rubber matting on the rear 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

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
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: 197750131
	VISIT DATE: 04/12/2022

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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.

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 30 School Age children, when the fire clearance is received, and fingerprints transferred, center will be re- licensed. Exit interview was conducted, report was read and a copy was given to the applicant.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
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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