367700305-1-20-2023-12-CC-KZIS-CN9V2Q-20230120150332

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700305
Report Date: 01/20/2023
Date Signed: 01/20/2023 03:03:50 PM

Document Has Been Signed on 01/20/2023 03:03 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:	LOBOS FAMILY CHILD CARE		FACILITY NUMBER:	367700305
ADMINISTRATOR:	MARTHA LOBOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 974-7577
CITY:	YUCCA VALLEY	STATE: CA	ZIP CODE:	92284
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	01/20/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Licensee, Martha Lobos		TIME COMPLETED:	03:15 PM

NARRATIVE

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On January 20, 2023 at 10:45am Licensing Program Analyst (LPA) Zirbes, conducted a Pre-Licensing inspection with applicant Martha Lobos to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee recently relocated and is requesting to provide care for a Large family childcare home for the capacity of 14 children at this new location. Fire clearance was granted on 1/17/23. Currently, there is one adult (applicant) and zero minor children living in the home. LPA toured the home indoor and out to ensure it meets FCCH requirements. Licensee is requesting the days and hours of operation will be Monday through Friday 6:00am - 5:3pm.
The home is described as follows:

This is a one story home consisting of four bedrooms, three bathrooms, kitchen, dining area/den, laundry room, family room, playroom, garage, front and back yard with an in ground pool. The off-limits areas: All four bedrooms, the primary bathroom, bathroom 2 (located down the hallway near the bedrooms), the garage, laundry room, and backyard. All the bedrooms, bathroom 2 and primary bathroom were inaccessible via a child safety gate, the laundry room was inaccessible via a child safety gate, the garage was inaccessible via a key lock, and the backyard was inaccessible via a locked sliding door and locked door. In addition the sliding door and door leading to the backyard were equipped with exit alarms. On limits: Playroom, family room, kitchen, dining area/den and the front yard.

Indoor:

Main area

Playroom: The play room was observed with cubbies for the children. doll house, blocks, a child size table with chairs, two high chairs, a changing table and additional age appropriate materials.

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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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: LOBOS FAMILY CHILD CARE	FACILITY NUMBER: 367700305
	VISIT DATE: 01/20/2023

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Report continued from page one
Bathroom: (Located near the playroom): LPA observed a toilet and sink. At the time of the inspection, the sink did not have running water, the light switch did not have a cover therefore sharp metal was exposed, , there were holes in the ceiling where the fan will be installed, the walls were not painted.
Family Room: LPA observed a couch, table, fireplace, cots and one play yard. The fireplace in the living room was equipped with mesh screen. The mesh screen does not prevent access by the child care children. LPA advised the applicant that the fireplace had to be inaccessible to the children via a secured barrier.
Den: LPA observed a couch, table and four chairs, and two play yards.
Kitchen: LPA observed cleaning products under the kitchen sink and knives and sharp objects in the cabinets. Sharp items were relocated to a high inaccessible cabinet. The refrigerator, dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly. .
Front Yard: The font yard is not fenced and the Licensee understood that constant supervision is required. LPA observed climbing equipment (Octagon climber, airplane, and slide) LPA observed the slide was not secured to the ground and was not stable. LPA observed the climbing equipment in close proximity to trees and a few large rocks were placed near the fall zones of the climbing equipment. LPA advised the Applicant that the fall zones surrounding the climbers must be met. LPA observed the plastic tiny tots table had a large rip on the plastic table top and therefore was not in good condition. LPA observed metal poles, boxes of supplies near the front entrance, cement blocks, a trailer, cactus and additional plants with sharp points.

Off-limit area
Bedroom 1: Furnished with a queen bed and personal furnishing.
Bedroom 2: Furnished with two full beds and personal furnishing.
Bedroom 3: Furnished with a queen bed and office supplies.
Primary bedroom and primary bathroom: Currently under construction and not being utilized
Bathroom #2: Located in the hallway between the bedrooms. LPA observed a shower, toilet and sink.
Laundry Area: Located between the kitchen and garage. Washer/dryer and storage area.
Attached Garage: LPA inspected the attached garage and observed household storage, work out equipment, tools and chemicals. The door leading to the garage was equipped with a key lock.

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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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: LOBOS FAMILY CHILD CARE	FACILITY NUMBER: 367700305
	VISIT DATE: 01/20/2023

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Report continued from page two

Backyard: The backyard has a cement patio and an upper dirt area with a retaining wall. Construction materials were observed throughout the area. LPA also observed an in ground pool and spa. The pool is surrounded by a 5’ removable mesh fence that is mounted into concrete. The gate opens away from the pool and is equipped with a self-closing, self-latching mechanism on top of the gate. At the time of this inspection the self -latching mechanism was not working. There was a table and chairs within three feet of the pool fence. LPA has advised the applicant to move the table and chairs further away from the fence. The licensee/applicant understands and agrees that the fence will remain in place whenever licensed care is provided.

Napping equipment: LPA observed one cot and three play yards. Applicant stated she has additional sleeping materials in storage.

Electrical outlets: All outlets in the home are tamper resistant receptacles.
Weapons or Firearms: Per the licensee, there are no weapons or firearms. LPA did not observe
any weapons or firearms.
Cleaning compounds: were observed in the bathroom and under the kitchen cabinet. The Applicant will make the items inaccessible to the children in care.
A smoke detector and a carbon monoxide detector tested and operable.
Fire extinguisher (2A10BC). Located in the laundry area. The fire extinguisher was purchased within the year.
Pet: There is one Bearded Dragon located in a glass cage in the den area. Per Licensee, the child care children will not interact with the bearded dragon.
Documentation:
Applicant has current CPR, First Aid Training with the expiration dates of 11/12/2024. Applicant completed the Prevented Health and Safety Training with the nutrition and lead components on 12/16/22 and mandated reporter training on 1/14/23. Applicant has fingerprint clearance and required immunization's on file. Per Applicant , transportation is provided. Per Applicant meals and snacks will be provided for children.
Report continued on page four

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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: LOBOS FAMILY CHILD CARE	FACILITY NUMBER: 367700305
	VISIT DATE: 01/20/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed Family Child Care Home. 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage atttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

Licensee advised visit www.shotsforschool.org for Immunization information.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Report continued on page five

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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: LOBOS FAMILY CHILD CARE	FACILITY NUMBER: 367700305
	VISIT DATE: 01/20/2023

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Report continued from page four

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Prior to being licensed the follow is required:.

1. Complete the construction on the bathroom located in the playroom.
2. The fireplace in the living room was equipped with mesh screen. The mesh screen does not prevent access by the child care children. LPA advised the applicant that the fireplace had to be inaccessible to the children via a secured barrier.
3. Cleaning products, sanitizing wipes, and medication were in observed in the lower cabinet of the bathroom off the playroom and in the cabinet under the sink. LPA advised the Licensee that all cleaning compounds, medicines and other items labeled keep out of reach of children had to be inaccessible to the children in care.
4. The self latching device on the gate needs to be fixed.
5. The debris must be removed from the front yard. LPA will provide applicant with additional guidance regarding the front yard after consulting with a Licensing Program Manager.

Licensee stated the above items will be completed within two weeks or sooner.

As a result of this inspection, the home does not meet Title 22 Regulations currently. Corrections are required. An exit interview was conducted, and a copy of this report and appeal rights were discussed with the Applicant Martha Lobos.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

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