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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401624
Report Date: 08/14/2024
Date Signed: 08/14/2024 10:24:35 AM

Document Has Been Signed on 08/14/2024 10:24 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:TABAE FAMILY DAY CAREFACILITY NUMBER:
197401624
ADMINISTRATOR/
DIRECTOR:		TABAE, EFFATFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 571-1521
CITY:WEST LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
08/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Effat TabaeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 8/14/2024 Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced case management inspection for the purpose of ensuring licensee has completed the Plan of Correction issued on 08/05/2024 and that home is meeting all Tittle 22 regulations and CA Health and Safety codes.

LPA arrived at the home and was greeted by Licensee Effat Tabae. LPA toured the home inside and outside and observed 7 children in care with Licensee and Licensee’s Husband providing care and supervision. Children were observed eating morning snack

Licensee has completed the plan of correction.

No deficiencies were cited during today’s visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1.

Upon on receipt of this report, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted, and report was reviewed with licensee A copy of this report and appeal rights were discussed and left with the licensee, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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