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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845859
Report Date: 09/14/2021
Date Signed: 09/14/2021 02:00:57 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:FAITH COMBSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 255-0233
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:14CENSUS: 12DATE:
09/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Licensee, Faith CombsTIME COMPLETED:
02:05 PM
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On 09/14/2021 at 12:16pm, Licensing Program Analyst (LPA) Destinee Hogue conducted a case management inspection with Licensee, Faith Combs. A case management inspection is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 08/25/2021.

During this inspection, LPA toured the facility inside and outside, took census of daycare children present on this date, conducted interviews with pertinent parties, reviewed records, and discussed the following with Licensee.

On or about 08/25/2021 at 1:20p Licensee self-reported an incident involving Licensee's minor child leaving the facility for approximately 40 minutes to one hour. Licensee stated while putting day care children down for a nap, Licensee's child left the home. Licensee stated her child went to the bathroom, and after bathroom use, Licensee's child decided to leave the house unattended and walk to the bike store located 0.9 miles from the facility on Beaumont Ave. Licensee informed LPA Hogue that law enforcement was called and the child safely returned to the facility at approximately 2:15pm. A worker at the bike shop, also contacted law enforcement to report a child had walked into the bike shop. Licensee installed locks with alarms for the doors inside and outside the facility. Licensee stated none of the day care children were aware of what happened and the day care children were napping when the incident occurred. Licensee informed parents about the incident and asked parents to pick up their children early.

Based on the reported information, there appears to be no violations of Title 22 Regulations pertaining to the reported incident, at this time.

An exit interview was conducted and a copy of this report was provided to Licensee. A notice of site visit was given and must remain posted for 30 days. No deficiencies were cited during this tele-inspection.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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