<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845859
Report Date: 01/06/2023
Date Signed: 01/06/2023 04:55:05 PM

Document Has Been Signed on 01/06/2023 04:55 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, 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: 0TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:27 PM
MET WITH:Faith Combs via telephoneTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Aman Sharma is concluding an investigation into a self reported incident received by Community Care Licensing on 08/29/2022. The Case Management investigation surrounding the incident was initiated on 08/31/2022. LPA was unable to meet with licensee, Faith Combs, as licensee has surrendered the license and relocated out of state. The facility is permanently closed effective 08/31/2022.

During the course of the investigation conducted by Community Care Licensing Investigations Branch (IB), Investigator, Charlotte Jackson; it was reported that a child put their genitals in another child’s mouth while in care at the facility on 08/26/2022.

During interviews, there were disclosures surrounding the inappropriate contact that confirmed the incident occurred as reported by licensee. The incident happened while licensee walked another daycare child to the door, licensee was in the next room for approximately 2-5 minutes when the incident took place. Although the incident happened, the IB investigation determined it was not due to neglect. Home daycare facilities do not require 100% visual supervision, so it was reasonable for licensee to leave the children while they walked another child to the door. Daycare parents also confirmed that the pick-up and drop-off’s were very quick. The parents were not allowed to enter the home due to the COVID-19 pandemic, unless specifically requested. Although the incident was not due to neglect, it did occur, therefore there was a violation surrounding a child’s personal rights.

An exit interview was not conducted with the Licensee, Faith Combs due to the licensee's relocation and this report being delivered via certified and regular mail. Appeal Rights were issued, and a copy of this report was provided.



A copy of this report must be made available to the public for 3 years, upon request.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/06/2023 04:55 PM - It Cannot Be Edited


Created By: Aman Sharma On 01/06/2023 at 04:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COMBS FAMILY CHILD CARE
FACILITY NUMBER: 334845859

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2023
Section Cited
CCR
102423(a)(1)

1
2
3
4
5
6
7
Each child receiving services from a family child care home shall have certain rights that shall not be waived/abridged by the licensee regardless of consent/authorization from the child's authorized representative. These rights include, but are not limited to, the following: (1) To be treated with dignity in
1
2
3
4
5
6
7
Licensee surrendered their license on 08/31/2022 and the facility is permanently closed.
8
9
10
11
12
13
14
his/her personal relationship with staff and other persons. This requirement was not met as evidenced by:
A child put their genitals in another child''s mouth while in care at the facility on 08/26/2022.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2