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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603547
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:25:29 PM

Document Has Been Signed on 10/03/2024 03:25 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TABITHA CARE CORPORATIONFACILITY NUMBER:
198603547
ADMINISTRATOR/
DIRECTOR:
ADELEKE, OMOBOLAFACILITY TYPE:
735
ADDRESS:14412 COKE AVENUETELEPHONE:
(562) 788-7639
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 6CENSUS: 9DATE:
10/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:Licensee/Administrator OmobolaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Tyler Reyes conducted a Plan of Correction visit (POC) to follow up on
the Complaint visit conducted on 09/26/24. The purpose of this visit is to follow-up on the POC that was due
on 09/27/24. Upon arriving at the facility, LPA met with Licensee/Administrator Omobola and explained the
purpose of the visit.

LPA Reyes conducted a complaint visit on 09/26/24 and cited the following deficiencies:
80010(a) - Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond
the conditions and limitations specified on the license, including the capacity limitation

During this visit LPA Reyes obtained copies of the staff roster client roster, and face sheets. LPA Reyes
observed (7) of (9) of the same clients observed on 09/26/24. Licensee Omobola confirmed the facility
continues to provide care and supervision to the same (9) clients observed by LPA on 09/26/24. The facility is
licensed for (5) Ambulatory and (1) Non ambulatory clients 18-59 years old. The facility continues to operate
over capacity with (9) clients and not within the approved fire clearance. Licensee Omobola states she had
made (2) attempts to notify local fire department.

At the time of today’s visit, facility is continuing to operate a facility beyond the conditions and limitations
specified on the license. Facility is currently providing care and supervision for (9) clients despite being
licensed and approved for 6) clients.

Civil penalties were assessed during today’s visit for the period of 09/28/24 – 10/3/24. Total amount noted on
the Civil Penalty (LIC 421) is $700.00 . Signatures on hard copy of LIC 421FC. Civil penalties will continue at
$100.00 per day until deficiency is corrected. Exit interview held and a copy of this report along with appeal\
rights were provided to Licensee Omobola.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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