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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202809
Report Date: 10/06/2023
Date Signed: 10/06/2023 06:24:15 PM

Document Has Been Signed on 10/06/2023 06:24 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:TRANSITIONAL LIVING CENTERFACILITY NUMBER:
547202809
ADMINISTRATOR:LEIGH (CABEJE), TAMARAFACILITY TYPE:
735
ADDRESS:546 E. TULARE AVENUETELEPHONE:
(559) 733-6648
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 38CENSUS: 30DATE:
10/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator (Admin) Tamara Leigh-by telephone; Mental Health Case Manager III (MHCMIII) Michelle TerryTIME COMPLETED:
06:30 PM
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A Case management visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Mental Health Case Manager III (MHCMIII) Michelle Terry. LPA spoke with Administrator (Admin) Tamara Leigh-by telephone & authorized MHCMIII to sign for receipt of reports.

Incident regarding client having episode in evening regarding self-harm. Staff increased supervision of client, contacted appropriate persons including Crisis Team, Visalia Police Department, & Emergency Services.

Facility followed policies & procedures. Client did not sustain injuries & received appropriate aftercare.

No further action needed @ time time.
Exit interview conducted MHCHIII. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2023
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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