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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700305
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:16:17 PM

Document Has Been Signed on 02/22/2024 03:16 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 CAREFACILITY NUMBER:
367700305
ADMINISTRATOR:MARTHA LOBOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 974-7577
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
02/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Martha Lobos TIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Zirbes met with Licensee Martha Lobos who guided analyst on a tour of the home for the Three year required inspection. The on-limit child care space includes the playroom, family room, den, bathroom (located within the playroom) and kitchen. The off limits areas are all bedrooms, laundry room, garage, and front and back yard were inaccessible via baby gates and locked doors/sliding doors. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 6:00am to 6:00pm. When LPA arrived LPA observed two infants and three preschool age children in care, during the inspection one more preschool age child arrived to the home. At approximately 10:35 a.m. LPA conducted a count of the children present in the Family Child Care home (FCCH). LPA observed Child (C1) a child under the age of two asleep in a play yard in the family room. C1 was laying on a loose article, a boppy pillow within the play yard. Furthermore LPA observed C1 was asleep in a play yard with a pacifier in C1 mouth. The pacifier was attached to C1s clothing. Licensee confirmed the pacifier was connected to C1 clothing. Based LPA observation and information obtained from the Licensee, two type B citations regarding infant safe sleep were issued. Refer to LIC 809D.
Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. LPA observed cleaning products and knives were stored on a high inaccessible shelf's in the kitchen, and bathroom. The fire extinguisher was purchased in January 2023 per the receipt taped to the fire extinguisher. Per LPA record review and information obtained from the Licensee the fire extinguisher has not been serviced. Therefore the fire extinguisher does not meet the State Fire Marshal standards, LPA issued a technical advisory notice as only 13 months have passed. Safe and age appropriate toys, play equipment and materials were present. LPA observed a smoke detector and carbon monoxide detector in the home. The home has central heating and air conditioning. LPA observed one outlet cover was missing a faceplate. LPA advised the Licensee to install a faceplate on the electrical outlet. All outlets in the home are tamper resistant. LPA did not observe baby bouncers/saucer chairs, or any recalled and or prohibited toys were observed on the premises Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 02/22/2024
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Report continued from page one

Per Licensee, there are zero firearms stored in the FCCH.

Bathroom (located near the play room): Toilet, sink, faucet were clean and operable. Cleaning products were stored on a high inaccessible shelf in the bathroom.

Outdoor: There is zero on-limits outdoor space at this FCCH. The front yard and backyard were inaccessible via a locked sliding door and locked doors. There is a in-ground pool in the off limits backyard. The pool is surrounded by a 5’ removable mesh fence that is mounted into concrete. At the time of the inspection the gate leading to the pool was locked and the Licensee was unable to locate the key. LPA was unable to verify the gate was self-closing and self-latching. The Licensee plans to purchase a new locking mechanism and will notify LPA when the new locking mechanism has been installed so LPA can verify the gate requirements. There are no items around the perimeter of the fence that would allow the fence to be climbable. The licensee understands and agrees that the fence will remain in place whenever licensed care is provided.

Per Licensee, there is a bearded dragon located in a cage in the off limit area of the home, no other pets live on the property at the time of this inspection.

LPA reviewed six child files and the Licensee file. At the time of this inspection, the Licensee did not have a personnel record containing the Licensees required documentation. Licensee expressed the Department had a current copy of the required records. LPA explained to the Licensee that a file was required on site for the Licensees records as well as any employees. LPA and Licensee reviewed the entrance checklist and the LIC 311. A technical advisory notice was issued. Per information obtained from the Pre-Licensing report LPA was able to verify the Licensee had a current CPR/First Aid Training and mandated reporter training.


Based on LPA child files review, Child 2, Child 3, and Child 4 files were missing documentation of their immunization's. A type B citation was issued refer to LIC 809D. Furthermore, based on Licensees statements the Licensee has not been documenting the infant safe sleep checks as required. Per LPA record review, the files were missing documentation of the 15 minute checks. Licensee stated she stays in the same location as the sleeping infant and checks on the infant, however the Licensee has not been documenting the infant safe sleep checks as required. A type B citation was issued Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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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: 02/22/2024
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Report continued from page two

Review of records to be maintained: LPA reviewed with licensee 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. Based on a conversation with the Licensee the fire/disaster drills are conducted in January and June of each year. Licensee stated the drills were not documented.

The following was discussed with the licensee:

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Report continued on page four
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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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: 02/22/2024
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Report continued from page three

During the exit interview, the LICENSEE Martha Lobos, confirmed that there are no Registered Sex
Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Based on LPAs record review there were four type B citations and four technical violations issued today, refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Martha Lobos.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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Document Has Been Signed on 02/22/2024 03:16 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 02/22/2024 at 01:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LOBOS FAMILY CHILD CARE
FACILITY NUMBER: 367700305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when C1 (15 month old infant) was observed asleep in the play yard. C1 was laying on a loose object, a boppy pillow within the play yard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2024
Plan of Correction
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Per Licensee, the loose item was removed from the play yard during the inspection. Licensee will review the infant safe sleep videos and forward them to the parents. Licensee will send LPA an email verifying the safe sleep information has been reviewed.
Type B
Section Cited
CCR
102425(b)(1)(A)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above when C1 was asleep in a play yard with a pacifier in C1s mouth. The pacifier was attached to C1s clothing, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2024
Plan of Correction
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Per Licensee, the pacifer will not be attached to the childs clothing while sleeping. Licensee will review the infant safe sleep videos and forward them to the parents. Licensee will send LPA an email verifying the safe sleep information has been reviewed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


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Document Has Been Signed on 02/22/2024 03:16 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 02/22/2024 at 01:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LOBOS FAMILY CHILD CARE
FACILITY NUMBER: 367700305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in three out of six child files were missing immunization information, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/29/2024
Plan of Correction
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Per Licensee, the immunization's paperwork will be added to the file or the parents will be asked to provide the updated information.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above when two of two infant files did not contain documentation of the safe sleep checks. Licensee confirmed the checks were not being documented. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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Per Licensee the 15 minute checks will be documented. A picture of the 15 minute checks be submitted every Friday to the Department until March 7, 2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


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