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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002443
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:17:46 AM


Document Has Been Signed on 03/30/2022 11:17 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:TABI'S FACILITY HOME CAREFACILITY NUMBER:
306002443
ADMINISTRATOR:CLAUDIA T. BISCOSFACILITY TYPE:
740
ADDRESS:2429 W. OLIVE AVENUETELEPHONE:
(714) 853-1313
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:6CENSUS: 2DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Claudia BiscosTIME COMPLETED:
11:31 AM
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Licensing Program Analyst (LPAs) Joseph Alejandre and Edward Tapia made an unannounced visit to conduct the required annual inspection (mitigation). LPAs were greeted and allowed entry by Claudia Biscos. Her administrator certificate expires on 11/28/2022. LPAs and administrator toured the facility.

Facility is a two story house with a total of 7 bedrooms and 5 bathrooms, living room, dinning room, laundry room and kitchen with an 2 car garage. The second story which has 3 bedrooms and 2 bathrooms is for staff only and is inaccessible to residents. LPAs observed all the resident bedrooms had the required furnishing and were clean and organized. All resident bathrooms (3) were clean and operational. Hot water measured bathroom 1 120.5 degrees Fahrenheit, 117.5 degrees Fahrenheit bathroom 2, 118.2 degrees Fahrenheit bathroom 3. Smoke detectors and carbon monoxide detectors were operational. LPAs observed that laundry room was inaccessible to residents with medications locked in a cabinet. LPAs and administrator toured the garage and backyard. The garage is kept locked and used for storage of food and supplies. No bodies of water observed in the backyard. The backyard opens up to the driveway with no exit gate. On the side of the house next to the kitchen there is an outdoor shaded seated area. LPAs and administrator toured the kitchen. LPAs observed 2 day perishable and 7 days nonperishable on hand. LPAs observed knifes are kept locked in a drawer. Facility has submitted a mitigation plan that is pending approval. LPAs consulted with administrator concerning continued COVID-19 mitigation procedures and reporting requirements.

No deficiencies observed in this visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy was provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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