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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617961
Report Date: 03/28/2023
Date Signed: 03/28/2023 01:06:28 PM


Document Has Been Signed on 03/28/2023 01:06 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:COMBEST, CYNTHIAFACILITY NUMBER:
343617961
ADMINISTRATOR:COMBEST, CYNTHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 560-3592
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 5DATE:
03/28/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Cynthia CombestTIME COMPLETED:
01:25 PM
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On March 28, 2023 Licensing Program Analyst (LPA) Lea Habtom made an unannounced plan of correction inspection to clear the deficiencies cited on March 3, 2023. The census for today was 5 day care children including 2 infants and 3 preschool being supervised by licensee Cynthia Combest.

LPA L. Habtom confirmed that the pack n play in the day care area had a fitted sheet and had no loose items such as blankets or stuffed animals. LPA L. Habtom also confirmed that licensee has LIC 9227 on file for infants under 12 months and also confirmed that licensee has documented 15 minute sleep logs for infants under age 2. LPA L. Habtom also verified that licensee has collected immunization's for children in care. LPA L. Habtom reminded licensee to collect immunization's prior to beginning care. Licensee has registered for the CPR course dated April 15, 2023 and will email LPA L. Habtom a copy of the certificate once she has completed the course in order to clear the citation.

Based on today's inspection LPA L. Habtom cleared a few of the deficiencies cited on March 3, 2023 and provided plan of correction letters.

No Title 22 regulations were cited during today's inspection. The report was reviewed with licensee, Cynthia Combest. A notice of cite visit was provided to be posted for 30 days. Appeal rights given.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
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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