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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320401
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:37:25 PM

Document Has Been Signed on 02/20/2024 03:37 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:TABITHA CARE IIFACILITY NUMBER:
198320401
ADMINISTRATOR:ADELEKE, OMOBOLAFACILITY TYPE:
735
ADDRESS:20 EAST MARKET STREETTELEPHONE:
(626) 639-9186
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 4CENSUS: 0DATE:
02/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Licensee Omobola AdelekeTIME COMPLETED:
02:45 PM
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On 02/20/24 Licensing Program Analyst (LPA) Villegas conducted an announced visit to the facility for purpose of a requested an increase of capacity. Facility was approved for an increase of capacity by the LB fire department 02/07/24, approved increase is from (4) clients to (6) clients. LPA met with Licensee Omobola Adeleke.

Facility is a single-story home located in a residential neighborhood and consist of the following: (3) client bedrooms which has (2) twin beds per room, (2) shared bathrooms, living room, dining area large enough for (6) clients, a kitchen, an outdoor laundry area, a shaded area with two locked cabinets used for toxins and additional storage space. The facility has board games, books, and other recreational materials for the client's use, commensurate with the plan of operation. Passageways, walkways, driveways, steps, and patios are free from obstructions. No bodies of water nor firearms are on the property.

The client bedrooms are spacious and will accommodate the (6) client's furnishings. Beds have the required linen/supplies which include pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen and hygiene products stored in a cabinet in the dining area. (2) Chairs, (2) lamps and (2) dressers were all observed in addition to closet space big enough for (2) clients to share per room.
One (1) fire extinguisher is mounted in kitchen and a second extinguisher is located under the kitchen sink. Smoke and carbon monoxide detectors are interconnected and are operational. A landline and internet service were observed. A supply of dishes, cups, and flat ware enough for (6) clients was observed to be new and in good repair and are stored in the kitchen cupboards. Knives, cutlery, and other sharp kitchen utensils are stored in a locked drawer in the kitchen area. Stove burners, microwave, refrigerator, and freezer are all operational. Refrigerator and freezer are large enough to store food to accommodate (6) clients, water temperatures measured between 105-120 degrees F.

A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in a locked drawer in the living
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TABITHA CARE II
FACILITY NUMBER: 198320401
VISIT DATE: 02/20/2024
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room, available for staff use but inaccessible to clients. Cash resources will be locked and stored with P & I ledger, accessible to designated staff, along with staff and client records which shall be stored in a locked cabinet in the dining area and the section has been inspected.

Based on tour of facility, facility has enough space to accommodate (6) clients in care. The increase of capacity will be effective on 02/20/24.

An exit interview was conducted with Licensee Omobola Adeleke, and a copy of this report has been provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
LIC809 (FAS) - (06/04)
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