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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201251
Report Date: 04/10/2023
Date Signed: 04/10/2023 01:49:32 PM

Document Has Been Signed on 04/10/2023 01:49 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:TABBY CARE HOME, LLCFACILITY NUMBER:
079201251
ADMINISTRATOR:GITHII, GEORGE N.FACILITY TYPE:
735
ADDRESS:708 PRESERVATION STREETTELEPHONE:
(925) 305-6596
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 0DATE:
04/10/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:George Githii, Licensee/AdministratorTIME COMPLETED:
02:00 PM
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On 04/10/2023 at 12:15PM, Licensing Program Analyst (LPA) L. Hall conducted an announced pre-licensing inspection. LPA met with George Githii, Licensee/Administrator. The facility has an approved fire safety clearance for six (6) ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage and back yard. The facility has a total of six (6) bedrooms, one (1) being used for staff (Master bedroom) and three (3) full. There were no bodies of water present during inspection. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Passageways and hallways are free of obstruction. Locked cabinet available to store medications, toxins, and sharps. Hot water temperature is measured at 105.0 degrees Fahrenheit. Fire extinguisher was last services on 06/30/2022. There is a minimum of 7-day non-perishables and 2-day perishables foods. Carbon monoxide and smoke detectors present. First-Aid kit complete.

Prior to licensure, the following shall be corrected and faxed to CCL by 04/24/2023.
  • Licensee will update facility sketch showing shared bedrooms and staff room.
  • Place non-skid mats in bath tubs.
  • Repair bedroom window screens.
  • Purchase hygiene products for clients.
  • Purchase activities/games.
  • Rearrange bedroom so that window is not blocked.
  • Post all required posters in facility.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TABBY CARE HOME, LLC
FACILITY NUMBER: 079201251
VISIT DATE: 04/10/2023
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Continued from LIC809.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC809 (FAS) - (06/04)
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