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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201251
Report Date: 04/25/2023
Date Signed: 04/25/2023 12:03:08 PM

Document Has Been Signed on 04/25/2023 12:03 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:
04/25/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:George Githii, Licensee/AdministratorTIME COMPLETED:
12:10 PM
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On 04/25/2023 at 11:15AM, Licensing Program Analyst (LPA) L. Hall conducted an announced continuation 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. All bathrooms have non-skid mats. The window screens have been repaired. Licensee have purchased hygiene products and activities/games. Fire inspector approved updated sketch for fire clearance.

LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations.

No issues noted during inspection. LPAs observed that facility is 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 conduct and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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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