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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841348
Report Date: 03/18/2022
Date Signed: 03/18/2022 02:12:48 PM


Document Has Been Signed on 03/18/2022 02:12 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
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: 3DATE:
03/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Jennifer Zirbes licensee TIME COMPLETED:
01:32 PM
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License Program Analyst's (LPA's) Steven Montoya and Justin Dorsey conducted case management to inspection the Zirbes Family Child Care Home. LPA met with Licensee Jennifer Zirbes. The purpose of the visit was to complete a health and safety check.

Present at time of inspection, children in care (1) infants, (2) toddlers with 1 staff (licensee) and licensee ratio was within State regulatory guidelines. LPA Montoya and Dorsey inspected the home for health and safety compliance. Licensee was receptive to visit and reports her assistant Francis Robles would be returning from picking up 6 School age children.

A copy of the report and appeals right was left with the licensee as well as the notice of site visit.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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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