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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700305
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:30:26 PM

Document Has Been Signed on 12/05/2024 04:30 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: 5DATE:
12/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:16 PM
MET WITH:License Martha LobosTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On December 5, 2024, Licensing Program Analyst (LPA) Zirbes conducted a case management deficiencies inspection to address additional information discovered. LPA met with Licensee Martha Lobos. Present during today's inspection were three infants and two school age children with the Licensee providing supervision.

The Department discovered through confidential interviews that the Licensee provided care and supervision to child 1 (C1) in the licensee’s home for periods of more than 24 hours per day from October 31, 2023, to Friday, November 3, 2023, and September 17, 2024, to September 19, 2024. Licensee stated care is provided 6:00am to 5:30pm Monday to Friday. Licensee confirmed care was provided for over 24 hours to one family two times. A type B citation for regulation 102352(f)(1) Definitions is being issued as this was a potential risk to the children in care. Refer to LIC 809D.



In addition, the Department discovered through interviews that the licensee failed to meet the reporting requirements. An unusual incident occurred on September 18, 2024, involving child 1 (C1), child 2 (C2), and child 3 (C3) being dropped off at Yucca Valley elementary prior to the school gate opening. Furthermore, the Licensee reported to LPA that on an unknown date the childcare was evacuated due to a fire at the next-door neighbor’s home. Licensee confirmed on 10/1/24, that the Department was not notified about the above incidents. These incidents were unusual incidents that threatened the physical, emotional health or safety of the children in care, therefore a report should have been made to the department. A type B citation for regulation 102416.2 (b) Reporting Requirements is being issued as this was a potential risk to the children in care. Refer to LIC 809D.
The Department conducted an unannounced inspection to the family child care on October 1, 2024. During the inspection, LPA conducted a review of child 2 (C2) file. When Licensee provided a copy of C2 file, Licensee stated C2 does not have immunization's therefore the License had the parent sign a statement.
Report continued on page one
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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: 12/05/2024
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Report continued from page two

When LPA reviewed C2 file, LPA observed a written statement expressing C2 was not currently receiving the recommended vaccination for their age. C2 did not have a medical exemption. A review of C2 records revealed C2 enrollment date in the family child care was September 17, 2024. Based on record review and information obtained from the Licensee, C2 did not have the required immunizations prior to admission in the family child care. A type B citation was issued for regulation, 102418 (a) Immunizations. Refer to LIC 809D.

Notice of Site Visit was given and must remain posted for 30 days. An exit interview was conducted with Licensee Martha Lobos. Appeal rights and a copy of the report were provided to Licensee Martha Lobos.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 12/05/2024 04:30 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 12/05/2024 at 03:11 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: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2024
Section Cited
CCR
102352(f)(1)

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102352 Definitions (f)(1) "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home, for periods of less than 24 hours per day … This requirement was not met as evidenced by:
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Per Licensee, care will not be provided for more than 24 hours. The Licensee will provide a written statement to the Department by 12/09/2024.
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Based on interviews, care and supervision was provided to C1 in the licensee’s home for periods of more than 24 hours. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
12/12/2024
Section Cited
CCR102416.2(b)

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102416.2 Reporting Requirements (b) The licensee shall report…events as specified in… 1597.467…(b)(1)(C) that occur during the operation…(C) Any unusual incident…threatens the physical or emotional health or safety of any child…This requirement was not met as evidenced by:
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Per Licensee, the CDSS training regarding reporting requirements will be completed this weekend. The Licensee will send a written statement to the Department confirming the training was reviewed.
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Based on interviews, the licensee did not report two incidents that were unusual and threatened the emotional health or safety of the children in care. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/05/2024 04:30 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 12/05/2024 at 03:12 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: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2024
Section Cited
CCR
102418(a)

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102418 Immunizations (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17…This requirement was not met as evidenced by:
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Per Licensee, C2 was disenrolled on 10/1/2024. Licensee reported all child files are reviewed prior to admission to ensure immunizations meet the Title 17 requirements.
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Based on interviews and record review C2 was enrolled on September 17, 2024, and did not have the required immunizations prior to enrollment. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
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