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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216352
Report Date: 04/17/2026
Date Signed: 04/17/2026 04:00:20 PM

Document Has Been Signed on 04/17/2026 04:00 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:COBARRUBIAS FCC AKA LAZARO FAMILY CHILD CAREFACILITY NUMBER:
426216352
ADMINISTRATOR/
DIRECTOR:		ARACELI LAZARO COBARRUBIASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 332-2052
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
04/17/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Araceli Lazaro CobarrubiasTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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On April 17th, 2026, at 02:05 P.M, Licensing Program Analyst (LPA) Fernando Hernandez conducted an unannounced Annual Random inspection at the above Family Childcare Home (FCCH). The FCCH operating hours are Monday to Friday from 6:00 AM to 04:00 PM. Licensee provides care for children from 6 months to 13 years of age. During the inspection, LPA met with Licensee Araceli Lazaro Cobarrubias who reports only (2) adult(s) live in the home and have received a criminal record clearance. Alongside the Licensee we toured the interior and exterior of the home. At the time of inspection, the Licensee was caring for (2) children.

LPA notes the residence is a single-story home. The accessible area(s) in the home includes the (1) hallway bathroom, dining room, kitchen, enclosed outdoor backyard, and living room for daily activities and napping. The inaccessible areas include the (1) bathroom, attached garage, and (4) bedrooms. LPA notes kitchen knives are kept in the inaccessible kitchen cabinet. LPA also observed a child safety gate to ensure kitchen is inaccessible when licensee is prepping food for children in care. LPA notes the detergents and cleaning supplies are kept in the inaccessible garage located in the kitchen area, LPA also observed the garage door with a child safety lock. LPA notes all inaccessible areas were observed to have child safety locks ensuring inaccessibility to children in care. The required licensing forms are posted in a prominent location. LPA observed age-appropriate toys and equipment, inside and outside the home. LPA notes the children’s bathroom was observed to be free of toxins. The Licensee confirmed there are no firearms and ammunition within the home. LPA observed no bodies of water. CONTINUED ON LIC809-C PAGE 2

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2026
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 04/17/2026 04:00 PM - It Cannot Be Edited


Created By: Fernando Hernandez On 04/17/2026 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: COBARRUBIAS FCC AKA LAZARO FAMILY CHILD CARE
FACILITY NUMBER: 426216352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (observation) & (record review), the licensee did not comply with the section cited above in (2) infant children did not have a safe sleep log which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2026
Plan of Correction
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Licensee will submit a copy of infant safe sleep log to LPAs email Fernando.Hernandez@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Fernando Hernandez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2026


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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: COBARRUBIAS FCC AKA LAZARO FAMILY CHILD CARE
FACILITY NUMBER: 426216352
VISIT DATE: 04/17/2026
NARRATIVE
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LPA reviewed the facility file and found that the licensees Pediatric CPR and First Aid certificate will expire on 03/26/28. Additionally, LPA reviewed licensees’ current Mandated Reporter Training Certificate expires on 03/17/28. LPA reminded that it is their responsibility to renew the certificates every two years. The regulation fire extinguisher (2A10BC) was observed with a service date 11/26/2025. LPA informed licensee it is their responsibility to annually service or purchase regulated fire extinguisher. LPA tested carbon monoxide and smoke detector combination alarm at 02:33 P.M and found functional. LPA notes has not conducted a fire/disaster drill within the last 6 months (10/14/2025), at the time of inspection Licensee conducted a fire/disaster drill dated 04/17/26, a technical violation will be cited based on observation.

LPA reviewed 2 out of 2 children's records to be complete. LPA reviewed infant sleep log to be incomplete, LPA notes (2) infant safe sleep logs were incomplete, a Type B deficiency will be cited based on record review (please see LIC809-D page for further information). LPA reviewed children’s Roster to be complete.

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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

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. CONTINUED ON LIC809-C PAGE 3

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: COBARRUBIAS FCC AKA LAZARO FAMILY CHILD CARE
FACILITY NUMBER: 426216352
VISIT DATE: 04/17/2026
NARRATIVE
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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-and-resources/safe-sleep as an additional resource.

LPA also informed licensee, 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. 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) or (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

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

During today’s inspection (1) Type B deficiency and (1) Technical Violation were cited based on observation and record review (please see LIC809-D page for further information).

A Notice of Site Visit was issued and must be posted for 30 days.

Appeal rights were given.

Exit interview conducted and report was reviewed with the Licensee Araceli Lazaro Cobarrubias.

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC809 (FAS) - (06/04)
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