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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841348
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:55:49 PM

Document Has Been Signed on 09/28/2021 03:55 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: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
09/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Jennifer ZirbesTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Lady King-Lewis conducted a Case Management inspection to verify the license facility capacity and ratio are within compliance. LPA met with licensee Jennifer Zirbes and toured the day care areas of the home. Upon arrival, LPA observed, 1 infant and 3 toddlers being cared for by licensee's assistant #1 in the rear yard. Around 3:30 Licensee other assistant #2 arrived to the home with 7 school age children. Prior to LPA exit, 7 children were picked up by parents. The facility was observed to be in capacity and ratio compliance.

An exit interview was conducted and a copy of this report and a notice of Site Visit was provided to the licensee.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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