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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002443
Report Date: 03/19/2024
Date Signed: 03/19/2024 11:07:35 AM


Document Has Been Signed on 03/19/2024 11:07 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
ORANGE COUNTY RO, 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: 0DATE:
03/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Claudia Biscos, licenseeTIME COMPLETED:
11:15 AM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a required annual visit. LPA was greeted and granted entry by Claudia Biscos, Licensee and Administrator after introducing himself and stating the purpose of the visit.

LPA was informed that licensee had notified the Department that no residents were in care since the last admitted resident passed away in July 2023. LPA accompanied with administrator conducted a walk-through of the physical plant and confirmed that the facility was not currently in operation.

No deficiencies cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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