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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841348
Report Date: 07/21/2022
Date Signed: 07/21/2022 01:33:31 PM


Document Has Been Signed on 07/21/2022 01:33 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: DATE:
07/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Jennifer ZirbesTIME COMPLETED:
02:00 PM
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Lady King-Lewis, Licensing Program Analyst discuss with Jennifer Zirbes, licensee for the purpose of reviewing the conditions set forth in the Stipulation and Waiver; and Order agreed on dated 06-21-22 and ordered to be effective 07/08/22.

Licensee agrees to a three year probation of her license. The probation shall commence on 07/08/22 and shall continue through 07/08/25 which time licensee shall be granted a probationary license subject to the following terms and conditions.
The Probation conditions are as follows:
A. Licensee shall operate the facility in strict compliance with the regulations and statutes governing the operation of a family childcare home.

B. During the period of probation, the Department in its sole discretion may conduct unannounced site visits for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of a family childcare home.

C. Licensee is required to maintain an accurate, complete and current client roster which must be made available to the department upon request.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 07/21/2022
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D. Licensee shall complete 24 hours of Bright Horizons training on topics including, but not limited to: care and supervision, capacity/ratio, reporting requirements, personal health and safety, and best practices in child care settings. Licensee agrees that she shall contact licensing if she has any questions regarding the training described herein.

E. Licensee shall retain the sign-in/sign-out sheets submitted to resource and referral agencies, and shall provide said sign-in/sign-out sheet for inspection by licensing staff upon request.

Upon successful completion of probation, the licensee's license shall be restored to its unrestricted capacity.

Licensee is informed that the term of Probation is from 07/08/2022 through 07/08/2025. Licensee was provided with a copy of the Probationary License during this visit.

Licensee shall forward copies of signed LIC9224 (Acknowledgement of Receipt) forms for the above referenced Decision and Order/Probation notification, as required per probation condition letter

Licensee Jennifer Zirbes was provided a current copy of the probation license to be posted, a signed copy of this report and Notice of Site Visit was provided to licensee during this inspection.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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