364841348-9-20-2023-12-CC-AVIA-CVUQGD-20230920120921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364841348
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:10:03 PM

Document Has Been Signed on 09/20/2023 12:10 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	ZIRBES FAMILY CHILD CARE		FACILITY NUMBER:	364841348
ADMINISTRATOR:	ZIRBES, JENNIFER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 201-9261
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	09/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jennifer Zirbes, Licensee		TIME COMPLETED:	12:30 PM

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On September 20, 2023, Licensing Program Analyst (LPAs) Annelise Villa and Evelyn Garcia met with Jennifer Zirbes who guided analysts on a tour of the facility for the One Year Required inspection. Upon arrival, LPA observed 5 children in care, 2 infants, 2 preschool aged children and 1 school aged child, along with the licensee's minor son. Residents of the home include licensee, her minor son, her daughter and fiancé . Hours of operation are Monday-Friday 4:30 am to 5:30 pm. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: This is a single story 4 bedroom, 2 bathroom home with kitchen, living room, dining room, family room, back yard and garage. Main care is provided in the child care room located at the left rear of the home adjacent to the kitchen/ dining area. Children use the bathroom in hallway on the left near the living room. Children have access to the Childcare room, restroom, kitchen and living room dining room, and backyard. Off limit areas include all bedrooms (key locked), bathroom #2, front yard, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons. Cleaning supplies, medications and alcohol were inaccessible to children in care.

Safe and age-appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets were inaccessible. No recalled and or prohibited toys or play equipment were observed on the premises. There is a designated area for ill children as necessary. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working a telephone. LPAs observed a barricaded fire place in the kitchen/dining area. The fire place was barricaded by a glass door and storage items, making it inaccessible to children in care.

Bathroom: Children use the bathroom in hallway on the Left. LPA observed toilet and faucet are clean and operable. Materials or items were observed in bathroom #1, LPA observed bathroom items under the sink with a safety latch.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ZIRBES FAMILY CHILD CARE	FACILITY NUMBER: 364841348
	VISIT DATE: 09/20/2023

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Kitchen: The kitchen is off limits to children in care. Sharp utensils are kept in a kitchen drawer with safety latch, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Breakfast, Lunch and snacks are provided. Licensee stated she is a participant in a food program, Ventura County Food Program.

Outdoor: Children play in the back yard. LPA toured the back yard and observed it to be free of garden tools, poisonous plants, thorn trees, cactus, or lawn mower inaccessible to children. The play area is clear and clean of debris, play area is fenced and gated all around. LPA observed age appropriate play equipment for children. There is a dog run that is pad locked and located in a off limits part of the backyard. There is a large play structure that is accessible located on top of grass. There is a chicken coop in the corner of the backyard and four dogs on the premises.

Pools/Spas/Bodies of Water: There are no bodies of water on the premises.

Advisory/Other: First Aid kit was observed in the childcare area with supplies readily available. CPR/First Aid expires on 1/29/2024. Mandated Reporter Training Certificate expires on 2/15/25. LPA reminded licensee mandated reporter training and CPR must be completed every 2 years.

The facility annual fees are current. Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Last fire/disaster drill was completed on 8/25/23.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have childcare insurance.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ZIRBES FAMILY CHILD CARE	FACILITY NUMBER: 364841348
	VISIT DATE: 09/20/2023

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Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC809 (FAS) - (06/04)

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