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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841348
Report Date: 06/28/2021
Date Signed: 06/28/2021 01:19:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ZIRBES FAMILY CHILD CAREFACILITY NUMBER:
364841348
ADMINISTRATOR:ZIRBES, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 201-9261
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: DATE:
06/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Melissa ReyesTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Lady King conducted a Case Management inspection to verify the license facility capacity and ratio are within compliance. LPA met with licensee's assistances Melissa Reyes and minor assistance and toured the day care areas of the home. Upon arrival, LPA observed 1 preschool, 5, school age children and 2 infants being supervised by the licensee's assistants. The facility license capacity and ratio were within compliance.

During this inspection LPA provided licensee staff declarations to complete. Licensee arrived about 45 minutes later and provided LPA copies of May CCRC sign in sheet, a total of 12.

An exit interview was conducted and a copy of this report was provided to the licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
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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