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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700305
Report Date: 06/17/2025
Date Signed: 06/17/2025 04:45:20 PM

Document Has Been Signed on 06/17/2025 04:45 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/
DIRECTOR:		MARTHA LOBOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 974-7577
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
06/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Licensee, Martha LobosTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Zirbes and Cha met with Licensee Martha Lobos who guided analyst on a tour of the home for the Annual/Random inspection. The on-limit child care space includes the playroom, family room, den, bathroom (located within the playroom). The off limits areas are all bedrooms, laundry room, garage, kitchen, and front and back yards. The off limit areas were inaccessible via baby gates and locked doors/sliding doors. According to the Licensee currently living in the home, is the Licensee, and Adult 1 (A1). Adult 2 (A2) was at the home at the time of the inspection visiting for a few days. LPA did not observe A2 during this inspection, Licensee expressed A2 does not provide care and supervision to the children. All adults who were required to have eligible clearances are cleared and are associated to the facility. Current days and hours of operation are Monday through Friday 6:00am to 5:30pm.
Upon LPA arrival there were four children in care (two infants under the age of one and two children over the age of two). Based on LPA observation the home was meeting the capacity/ration requirements.
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 did not observe cleaning products in the on limits space. Per Licensee, knives, medications and cleaning products are stored in the off limits spaces. The fire extinguisher was purchased in March 2025 per the receipt taped to the fire extinguisher. During the inspection of the home, LPA observed child 1 (C1) sitting on the floor in a green Bumbo Baby Sitter Seat in the playroom of the family child care. LPA reviewed the Consumer Product Safety Commision (CPSC) website while present in the home. Per LPA review the Bumbo seat was recalled by CPSC. LPA observed the Bumbo Baby Sitter was not equipped with a restraint belt. LPA discussed the Bumbo Baby Sitter Seat with the Licensee. Report continued on page two
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/17/2025 04:45 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 06/17/2025 at 03:38 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: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)(1)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials. (1) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used for children in care or accessible to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and observation, the licensee did not comply with the section cited above in Child 1 was observed sitting in a Bumbo Baby Sitter Seat on the floor in the playroom. Per CPSC this item was recalled. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Per Licensee, the item was removed and the item will not be utilized. The Licensee will provide the Department with a signed statement that the item will not be utilized.
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

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 four faceplate covers were missing, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2025
Plan of Correction
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Per Licensee faceplate covers will be purchased and installed. A picture of the corrections will be submitted to the Department.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Kendal Zirbes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/17/2025 04:45 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 06/17/2025 at 03:38 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: 06/17/2025

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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Based on record review, the licensee did not comply with the section cited above in two of six child files reviewed did not contain documentation of the immunizations (child 1 and child 2). which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Per Licensee, a copy of the immunizations will be obtained from the authorized representative. The Licensee will notify the Department when the records have been obtained.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two of two infant files (child 1 and child 3) reviewed did not contain the LIC 9227 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2025
Plan of Correction
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Per Licensee, the LIC 9227 will be completed by the parent and added to the child files. The Licensee will notifiy the Department when the LIC 9227 has been obtained.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Kendal Zirbes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


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: 06/17/2025
NARRATIVE
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Report continued from page one
Per Licensee they were not aware of the recall and the Licensee expressed the item was provided by a parent. Licensee expressed they do not use the Bumbo Baby Sitter frequently. Based on LPA observation, the family child care was utilizing a recalled item therefore this is a potential risk to the children in care, a type B citation was issued, refer to LIC 809D. LPA observed a combination smoke detector and carbon monoxide detector in the home. When the equipment was tested a beep was heard therefore the equipment was in working order at the time of the inspection. The home has central heating and air conditioning. LPA observed the faceplate surrounding the cable outlet was missing two screws and was not secured to the wall. The cable outlet was located approximately 18 inches off the floor in the dining room. In addition, LPA observed three light-switches located in the dining room and family room were missing the faceplate covers. The light switches were located approximately four feet high on the wall. When the observation was discussed the with Licensee, they expressed the screw must have been removed and the faceplates were not replaced during construction. The missing faceplate covers are a potential risk to the children in care, a type B citation was issued refer to LIC 809D. Per Licensee, there are zero firearms stored in the FCCH.
Bathroom (located near the play room): Toilet, sink, faucet were clean and operable.
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. The in ground pool is surrounded by a 5’ removable mesh fence that is mounted into concrete. There was one gates that provide access to the in ground pool. The mesh gate was observed to be self closing and self latching with a key lockable device placed no lower than 60 inches. LPAs observed there are zero items around the perimeter of the fence that would allow the fence to be climbable.  LPAs observed a life ring with a diameter of at least 17 inches with a United States Coast Guard approval label. LPA observed a 12 foot rescue pool with a net attached to the end and a second 12 foot rescue pole with a pool broom attachment. Licensee confirmed they do not have a body hook, however expressed in an emergency they can use the net and pool broom to provide assistance. LPA advised the Licensee that a body hook is required per Title 22. A technical advisory notice was issued. LPAs observed a pool alarm placed in the pool. The pool alarm was tested and found to turned on and in working condition. LPAs heard the alarm make an audible sound inside the home. At the time of this inspection, the Licensee was able to provide documentation that the alarm was compliant with ASTM International Standard F2208. Continued page three
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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: 06/17/2025
NARRATIVE
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Report continued from page two

LPA asked the Licensee if they had been performing a daily inspection of the safety equipment and the drowning prevention safety features. Licensee expressed she checks the outdoor area however does not maintain a log of the inspection. LPA discussed the requirement with the Licensee. A Technical violation was issued. The licensee understands and agrees that the mesh 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, and one cat who live on the property at the time of this inspection.

LPA reviewed six child files and the Licensee file, and one household members file. Based on LPA review, Two of six child files reviewed did not contain documentation of the immunization's (child 1 and child 2). Per LPA review the PM 286 within the file was blank. When asked why the immunization's were not in the file, the Licensee expressed the parent had provided the immunization's paperwork however the paperwork must have fallen out of the file. A type B citation was issued, refer to LIC 809D. Two of two infant files (child 1 and child 3) reviewed did not contain the LIC 9227. When asked why the document was missing the Licensee shared they did not know about the required form. A type B citation was issued, refer to LIC 809D.


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 were conducted in January 2025.

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.



Report continued
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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: 06/17/2025
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Report continued from page four
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.

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 two 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.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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