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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364841348
Report Date: 05/27/2021
Date Signed: 05/27/2021 04:06:09 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2021 and conducted by Evaluator Lady King
COMPLAINT CONTROL NUMBER: 12-CC-20210524134007
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: 18DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Jennifer Zirbes TIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility is over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) King-Lewis met with licensee to deliver the complaint findings for the above allegation. During this investigation LPA observed 18 children being care for by licensee and licensee’s two assistance. Licensee is currently licensed to provide care and supervision for 14 children.

The investigation consisted of review of facility roster, sign-in sheets, interviews conducted with licensee and children in care and LPA observation on May 27,2021.

During an interview conducted with licensee on May 25, 2021 licensee admitted that on a few occasions she provided care for more than 14 children at one time. Licensee informed LPA there has been times when she cared for 16 children at one time. The facility operated over the capacity specified on the license. Based on the evidence obtained, licensee’s admission and LPA observation during today inspection, the allegation of over capacity is substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 12-CC-20210524134007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 364841348
VISIT DATE: 05/27/2021
NARRATIVE
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The facility operated over the capacity specified on the license. Based on the evidence obtained and the licensee’s admission, and LPA observation the licensee was providing care for 18 children which included 4 infants.

A finding of substantiated means that allegation is valid because the preponderance of the evidence standard has been met. The facility is cited today in accordance to Title 22 of the California Code of Regulations.

The facility was cited type A deficiency according to the California Code Title 22 Regulations See Facility Evaluation Report LIC 9099D for deficiency.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

If these requirements are not met, civil penalties will be assessed.

An exit interview conducted, appeal rights discussed, and a copy of this report and the notice of site visit 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: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 12-CC-20210524134007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 364841348
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/28/2021
Section Cited
CCR
102416.5(d)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. This requirement was not met as evidence by Licensee admitted she provided care up to 16 children at one time on a few occasions and LPA observed 18 children on this inspection date May 27,2021.
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Licensee states she will maintain a schedule of children enrolled and in attendance to remain in compliance of her license capacity of 14 children at all times. Licensee will provide a declaration concerning the aforementioned statement and provide a copy of the current facility schedule to the Department no later than May 28, 2021.
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This is a type A deficiency which poses an immediate Health and Safety risk to children in care.
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Type A
05/28/2021
Section Cited
CCR
102371(a)
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FIRE SAFETY CLEARANCE: The home has fire clearance for 14 children. The Licensee was in operation and provided care to at least, 18 children at a time. The facility therefore is in violation of this section by failing to adhere to the license capacity granted by the State Fire Marshal.
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Licensee shall provide written statement stating how she will remain in compliance with the fire safety clearance. LPA provided licensee with capacity regulation visual for a license large family child care home capacity.
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This is a Type A violation and poses an immediate risk to the health and safety of children 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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2021 and conducted by Evaluator Lady King
COMPLAINT CONTROL NUMBER: 12-CC-20210524134007

FACILITY NAME:ZIRBES FAMILY CHILD CAREFACILITY NUMBER:
364841348
ADMINISTRATOR:ZIRBES, JENNIFERFACILITY TYPE:
810
ADDRESS:13467 DESERT PRIMROSE LANETELEPHONE:
(626) 201-9261
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 18DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Jennifer Zirbes TIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Provider is not at the facility the required number of hours.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) King-Lewis met with licensee to deliver the complaint finding for the above allegation. During this investigation LPA observed 18 children being care for by licensee and licensee’s assistance. 4 of the 18 children were infants.
The investigation consisted of a review of facility roster, sign-in sheets, interviews conducted with children in care, licensee, licensee’s assistants and LPA observation.
The licensee denies that she is away from the facility more than 80% of her operating hours. Disclosures obtained from interviews conducted with the aforementioned parties revealed conflicting information. Based on the evidence obtained the allegation is found to be unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interview was conducted, appeal rights discussed, and a copy of this report and the notice of site visit was provided to the licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4