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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500306709
Report Date: 01/29/2020
Date Signed: 01/29/2020 02:01:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:COMBS, FLORAFACILITY NUMBER:
500306709
ADMINISTRATOR:COMBS, FLORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 538-0932
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:14CENSUS: 10DATE:
01/29/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Flora CombsTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Robert Gutierrez, conducted an unannounced annual required 1 - year inspection and was met by Licensees, Flora Combs & Stanley Combs. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the entire first floor of the house and the backyard are accessible to children in care. All other rooms are off-limits and made inaccessible by use of a child safety gate. There are no swimming pools or other bodies of water on the premises. The outdoor play area in the backyard is fenced and there are no hazards to children present. There are no firearms or ammunition on the premises. Safe toys and play equipment are observed. Cleaning compounds, medication and other hazardous items are made inaccessible. No poisons were observed during inspection. Stairs are barricaded when children under age 5 years old are present. The fireplace located in the living room is made inaccessible by a glass screen and will not be in use during daycare hours. There is working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. No pets were observed. Capacity as specified on the license is being maintained. Ms. Combs pediatric CPR/First Aid expired on 01/20/2020. Mr. Combs was unable to provide his pediatric CPR/First Aid to LPA. Mr. Combs completed his Mandated Reporter Training on 02/09/2018. Ms. Combs completed her Mandated Reporter Training on 11/26/2018. An emergency fire/disaster drill has been completed within the last 6 months. A review of records indicates that immunization records are in file for children. Licensee has a current roster of the children. LPA reviewed a sample of children’s file and observed files were complete. Licensee maintains emergency information and forms as required. Licensee has a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and notification of parents rights poster are posted on the playroom wall. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday - Friday, 6:00 am to 7:30 pm.

Continued on 809-C

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: COMBS, FLORA
FACILITY NUMBER: 500306709
VISIT DATE: 01/29/2020
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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide these services. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

LPA and Ms. Combs discussed the use of baby equipment and how baby walkers are not allowed in a family child care home.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is found

(see next page): 809 D

Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: COMBS, FLORA
FACILITY NUMBER: 500306709
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2020
Section Cited

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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by observation and records review conducted during today’s inspection.
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Licensee Ms. Combs CPR card expired on 01/20/2020. Mr. Combs was unable to provide LPA with his CPR card. This poses as a potential risk to the health, safety, or personal rights of children in care.
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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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3