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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845859
Report Date: 02/10/2021
Date Signed: 03/12/2021 01:31:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:COMBS FAMILY CHILD CAREFACILITY NUMBER:
334845859
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
02/10/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Faith Combs, Licensee TIME COMPLETED:
08:00 AM
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Due to COVID-19, Licensing Program Analyst (LPA) Sharleen Robinson conducted a Case Management Licensee initiated Tele-inspection with Licensee Faith Combs. LPA met with the Licensee via FaceTime.

The Licensee has requested to add bedroom #4 to the on limits area and to remove bedroom 1 from the on limits area.

There were 2 children in care during the inspection. Licensee toured LPA through the facility inside and out. LPA inspected room #4, the remainder of the on limits areas, outside play areas and the gated in-ground pool area. No hazards observed, room #4 is approved for use as of today’s date.

No deficiencies were cited during this tele-inspection.

An exit interview was conducted via FaceTime. A Notice of Site Visit and a copy of this report was provided to Licensee on this date. LPA provided a copy of this report and Notice of Site Visit via email with an electronic “read receipt”. LPA requested the Licensee to acknowledge receipt of the email. The electronic read receipt of the emailed report acknowledges receipt of this report.

Licensee understands that a copy of this report must be made available to the public, upon their request, for the next three years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 233-7183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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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