198603547-8-9-2025-28-AS-LHIS-DKFQ6S-20250811115402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603547
Report Date: 08/09/2025
Date Signed: 08/09/2025 12:14:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250730103629

FACILITY NAME:	TABITHA CARE CORPORATION		FACILITY NUMBER:	198603547
ADMINISTRATOR:	ADELEKE, OMOBOLA		FACILITY TYPE:	735
ADDRESS:	14412 COKE AVENUE		TELEPHONE:	(562) 788-7639
CITY:	PARAMOUNT	STATE: CA	ZIP CODE:	90723
CAPACITY:	6	CENSUS: 6	DATE:	08/09/2025
		UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Daniel Adeleke - Caregiver		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is threatening resident.
Staff yelled at resident.
Staff is not providing resident itemized receipts.
Staff does not ensure residents are provided adequate food meals.
Staff does not ensure facility is free of pests.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent complaint visit to deliver findings on the allegations listed above. LPA met with Omobola Adeleke Licensee/Administrator and explained the purpose of the visit.

The investigation consisted of the following:
On 8/5/25 LPA conducted initial visit and toured facility inspected for pests and food supply, obtained copies of payments made towards Client #1 (C1) rent, C1's admission agreement, cleaning receipts from contracted cleaning services, food menu, and interviewed 1 staff and 5 clients.
On 8/8/25 LPA interviewed C1's Case manager and 2 staff via phone call.
During todays visit 8/9/25 LPA delivered findings to the above allegations.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20250730103629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TABITHA CARE CORPORATION	FACILITY NUMBER: 198603547
	VISIT DATE: 08/09/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff is threatening resident.
It is alleged that S1 has made threats to evict C1, due to failure to pay rent, however, it is believed that C1 has paid all rent fees and is now up to date with their rent payments. LPA reviewed invoices and payments, and it was observed that C1 has an outstanding balance of $368.18. When C1 was first admitted to facility only partial payment was received and it was agreed that C1 would pay the balance monthly, however, C1 has not yet brought down that balance to $0 and this is why there is an outstanding balance. Interview with S1 revealed that this information was provided to C1 both verbally and on paper, and S1 has warned C1 if the balance is not paid this may lead to an eviction but no eviction notice has been given. LPA spoke with Mental Health Agency Case Manager who is assigned to C1 who also confirmed there is a balance due and both C1 and their family member seem to change what they think the balance owed is, there have been conversations with Case Manager and C1 to pay the outstanding balance and its believed C1 has not yet paid. LPA interviewed a total of 3 staff and 3 out of 3 staff denied the above allegation and stated they have never threatened a client. LPA interviewed 5 clients and 4 out of 5 clients denied the above allegation and stated they have never been threatened by staff.

Allegation: Staff yelled at resident.
It is alleged that S3 yelled at C1 when C1 was trying to sign out for an outing. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated they have never yelled at a client and have not seen another staff yell at clients. LPA interviewed S3 and S3 stated they did not yell at C1 but they did ask C1 to sign the book, C1 got upset because there was no pen and raised their voice and S3 asked C1 to ask for a pen when there isn’t one there and that there was no yelling during the conversation. LPA interviewed 5 clients and 2 out of 4 clients denied the above allegation and stated they have never been yelled at by staff, interviews with C2 and C3 revealed that S1 has raised their voice/yelled at them but they did not feel it was in a threatening manner and feel that S1 means well. During interviews with S1 and S3 LPA observed both staff to have a high pitched voice that was loud but it was not perceived as yelling.

(continued on LIC9099-C)

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250730103629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TABITHA CARE CORPORATION	FACILITY NUMBER: 198603547
	VISIT DATE: 08/09/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff is not providing resident itemized receipts.
It is alleged that staff are not providing C1 with receipts of rent payments C1 has given. LPA interviewed C1 and C1 confirmed that they have received an invoice with breakdown of payment. LPA interviewed C1’s Case Manager and they confirmed that the facility and themselves have provided C1 with verbal details of the balance owed and that C1 has admitted they received a copy of the invoice from facility. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that C1 has been provided with a copy of the itemized rent payment invoice. LPA interviewed 5 clients and 4 out of 5 clients denied the above allegation, 3 clients stated that although they have not been provided with receipts they have not needed any as their rent is paid through another agency. Interview with C4 revealed that although they don’t get a receipt right away, they are eventually provided with one.

Allegation: Staff does not ensure residents are provided adequate food meals.

It is alleged that the facility does not provide clients with nutritious meals and clients are provided small portions of food. LPA toured kitchen and dining and observed a sufficient quantity of canned foods, fresh produce, meats/chicken and frozen vegetables. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that clients at the facility are very independent and often times do not want what is on the menu and will request a different meal, staff will make what is being asked. LPA interviewed 5 clients and 4 out of 5 clients denied the above allegation and stated that they are provided with 3 meals a day that they feel are decent and if more is desired they are provided with it.

Allegation: Staff does not ensure facility is free of pests.

It is alleged that facility has roaches. LPA toured facility and did not observe any roaches or droppings. LPA interviewed 3 staff and 3 out of 3 staff stated that there was a problem a month ago in early July, once the problem was discovered the facility was fumigated and there hasn’t been signs of roaches since. LPA interviewed 5 clients and 5 out of 5 clients also stated that there was a problem early July and the facility was fumigated and haven’t noticed any roaches since. This allegation was previously cited during the facility’s annual inspection 6/16/25 therefore no additional citation issued during visit. LPA reviewed the contract with pest control company dated 7/11/25 that indicates facility was treated for pest control, interior and exterior spray for ants, roaches, and spiders with the next scheduled service date of 9/5/25.

Based on statements/interviews conducted with staff/clients, review of files/records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held,a copy of this report was emailed

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3