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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700305
Report Date: 02/08/2023
Date Signed: 02/08/2023 10:54:02 AM

Document Has Been Signed on 02/08/2023 10:54 AM - 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 CAREFACILITY NUMBER:
367700305
ADMINISTRATOR:MARTHA LOBOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 974-7577
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/08/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Applicant Martha Lobos TIME COMPLETED:
11:00 AM
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On February 8, 2023 Licensing Program Analyst (LPA) Zirbes conducted an announced follow up Pre-Licensing inspection. LPA met with applicant Martha Lobos. The purpose of the inspection was ensure all corrections observed on January 20, 2023 had been completed. LPA and Applicant completed a tour of the home. LPA observed the following:

1. The bathroom which the Applicant will be utilizing for child care was observed to have functioning sink and toilet. The area was free from hazards.
2. The fireplace in the living room was equipped with a permanent barrier. Therefore the fireplace was inaccessible to the children in care.
3. Disinfecting wipes previously observed in the bathroom were relocated to the garage.
4. Medications previously observed in the bathroom were relocated to an off limits bathroom.
5. After being tested, the self latching device on the removable mesh fence surrounding the in ground pool is in working order.
6. The outdoor furniture was observed to be at least 6 feet away from the gate surrounding the pool.
7. The bouncer was removed from the playroom.
8. LPA and Applicant discussed that zero outdoor space on the property has been approved by the Department. The applicant has agreed to utilize a local park. LPA expressed the outdoor space could not be utilized by the child care children and if in the future the applicant wished to utilize the outdoor space, the area had to be approved by the Department prior to use. Applicant provided a written declaration to the Department.
During this inspection LPA and applicant discuss Adult 1 (A1). Applicant stated previously A1 resided at the address prior to the applicant. Applicant reported A1 does not resided at the license address. Applicant was made aware that A1 can not be in the home during operating days and hours. LPA completed a tour of the home on January 20, 2023 and today February 8, 2023 and did not observe A1 on the property. Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 02/08/2023
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Report continued from page one


As a result of this inspection, the home does meet Title 22 Regulations currently. Final approval is pending review by a Licensing Program Manager. 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: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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