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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603547
Report Date: 10/14/2024
Date Signed: 10/14/2024 10:26:09 AM

Document Has Been Signed on 10/14/2024 10:26 AM - 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:
10/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:12 AM
MET WITH:Licensee/Administrator OmobolaTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Tyler Reyes conducted a second 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.

Chronology:

On 10/3/24 LPA Reyes conducted a POC visit and deficiency was still not corrected. Civil Penalties (LIC 421) were issued in the amount of $700.00 . Signatures on hard copy of LIC 421. Exit interview held and a copy of this report along with appeal rights were provided to Licensee Omobola.


At the time of today’s visit, facility is continuing to operate a facility beyond the conditions and limitations
specified on the license. Licensee/Administrator Omobola confirmed the facility continues to provide care and supervision to the same (9) clients observed by LPA on 09/26/24. Facility is currently providing care and supervision for (9) clients despite being licensed and approved for (6) clients. Civil Penalties (LIC 421) was issued in the amount of $1100.00

Civil penalties were assessed during today’s visit for the period of 9/27/24 – 10/14/24. LPA provided a hand signed copy of LIC 809 and Appeal Rights to Licensee/Administrator Omobola
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
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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