197750131-11-1-2023-12-CC-JDMO-CX6VPS-20231101163713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750131
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:37:29 PM

Document Has Been Signed on 11/01/2023 04:37 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:	197750131
ADMINISTRATOR:	SANDRA LONA AGUIRRE		FACILITY TYPE:	840
ADDRESS:	43301 DIVISION ST. STE 101		TELEPHONE:	(661) 524-1042
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 14	DATE:	11/01/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Deborah Castillo		TIME COMPLETED:	04:40 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	On 11/01/2023, at 2:14 P.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo met with the Infant/Toddler Director, Deborah Castillo to conduct an unannounced One Year Required inspection for the school age license in accordance with the facility sketch. A tour of the facility was conducted. LPA observed a total of 14 preschool children for the classrooms (7 and 8 combined) with 2 staff (Teacher and Assistant Teacher-Float) providing supervision. The hours of operation are 6:00 A.M. - 6:30 P.M. Monday - Friday. Incidental Medical Services (IMS) was discussed. Indoor/Children’s Area: Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, ramps, and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean, cleaning compounds are inaccessible, poisons are locked, furniture/equipment is in good condition and is free of flies, other insects, and rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual or portable storage space (cubby, individually labelled with name) for his/her clothing, personal belongings, and or bedding (stored separately). There is a working telephone. Electrical outlets are inaccessible and has plastic covers. Recalled and or prohibited toys or sleep/play equipment were not observed on the premises. There are no window cords accessible to children. Trash bins for solid waste have tight fitting lids. Drinking water is provided in every classroom and is stored in a small water pitcher. Water dispensers and water fountains are available in the facility. Children bring their own bottle/container when drinking. All materials and surfaces are toxic free and are inaccessible. There is no fireplace in the facility. The center has an internal pull-down fire alarm system and fire extinguishers with a 2-A:10-B:C classification (last service date was 02/23/2022, reading in green, checked at 3:40 P.M.). Carbon monoxide and smoke alarm devices are in operable condition (checked at 3:38 P.M.).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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: 197750131
	VISIT DATE: 11/01/2023

NARRATIVE

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Restrooms: LPA inspected and observed a total 2 toilets and 2 sinks inside the school age bathrooms for boys and girls. There is an additional sink outside of the bathroom inside room 7 and 8. The LPA observed liquid soap, toilet paper, and trash bins with covers, were readily available. Water temperature is appropriate.

There is an isolation area for children who become ill while in care and is located in the main office. The facility maintains a comfortable temperature at all times, first aid supplies (first aid manual/guide, bandages, scissors, tweezers, antiseptics, gauze), electronic sign in/out sheets are available and completed daily. Smoking is prohibited on the premises, daily inspection for illness, no prohibited child care items observed. Firearms/weapons are not allowed or stored on premises. There is no body of water on the premises.

Napping: Per Director Castillo, school age children do not nap in the facility.

Outdoor: The facility has a playground area for school age children. The preschool and school age children share the same playground area and is scheduled at different time. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. The area was observed to be free of debris, free from hazard, holes, broken items, and debris. The slides have rubberized cushioning materials. No bodies of water were observed. According to the director, drinking water is provided during outdoor plays. Staff bring a water pitcher when they play outside, or children can go to room 108 (adjacent to the playground areas) which has two water fountains.

Teacher child ratios were observed, and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.

Health Related Services: According to Director Deborah Castillo, they were providing medications to children in care. LPA observed the facility has LIC9221 Parent Consent for Administration of Medications and Medication Chart.

Children are inspected for illnesses (wellness policy) as they arrive. Children were check with regards to their body temperature.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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: 197750131
	VISIT DATE: 11/01/2023

NARRATIVE

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equipment/supplies, and reviewed children’s, personnel, and administrative records. 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/childqanda.htm

Food Service: There is a clean microwave, refrigerators, and freezers available in the facility. The facility provides one hot lunch that is precooked for children. Children bring their own snacks.

Staff/Personnel Records: Director (qualified) qualifications were verified, Designation of Responsibility observed, immunization's, TB clearance for staff, health screening, criminal record statement, statement acknowledging suspected child abuse and mandated reporter were observed in file.

Facility Records: Roster, fire/disaster drills log was last completed on 10/19/2023 at 1:58 P.M. The facility is using an emergency alarm system with voice activation and is in room 304. Maintenance personnel and other staff check each room to make sure that no one is left behind. CPR/First Aid and mandated report trainings were reviewed. Staff # 1 and #1 have updated CPR/First Aid and mandated reporter training. Staff # 2 is advised to take the CPR/First Aid training, either through the American Red Cross, American Heart Association, or any Emergency Medical Services Authority (EMSA) certified and approved training centers.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394), emergency disaster plan, earthquake preparedness checklist.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Staff #1 and #2 completed the CPR/First Aid trainings on 02/13/2022 and 03/22/2023. Mandated Reporter Trainings were completed on 02/14/2022 and 01/25/2023.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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: 197750131
	VISIT DATE: 11/01/2023

NARRATIVE

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Sign in and out sheets were reviewed. The facility is using electronic sign in and out sheet. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current.

Director was advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of a day care center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the day care center, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

No deficiencies were cited during this inspection. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 A.M. -5 P.M.

Exit interview conducted and a copy of this report, Notice of Site Visit, and appeal rights were provide to Director Deborah Castillo.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

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