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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845859
Report Date: 08/31/2022
Date Signed: 09/16/2022 09:44:07 AM

Document Has Been Signed on 09/16/2022 09:44 AM - 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:COMBS FAMILY CHILD CAREFACILITY NUMBER:
334845859
ADMINISTRATOR:FAITH COMBSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 255-0233
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Faith CombsTIME COMPLETED:
03:45 PM
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**THIS IS AN AMENDED REPORT FROM 08/31/2022**
On this date and time, Licensing Program Analysts (LPAs) Aman Sharma and Laura Mejorado conducted a case management inspection with Licensee, Faith Combs. A case management inspection is being conducted in response to the receipt of a self reported Unusual Incident Report (UIR) concerning a child's personal rights. The UIR was received by the licensing agency on 08/29/2022. During todays inspection the facility was closed, and no children were present. Present in the home were licensee, Faith Homes, licensee's spouse, and licensees two children.

LPAs collected copies of pertinent documents and records. During todays inspection Licensee voluntarily surrendered and provided their license along with a written statement to LPAs. LPAs notified Licensee that an investigation into the incident will be conducted by Community Care Licensing Investigations Branch (IB) Investigator Charlotte Jackson.

LPAs conducted an exit interview with licensee and provided a copy of this report. A Notice of Site Visit was issued and must remain posted for the next 30 days.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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