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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202809
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:52:26 PM

Document Has Been Signed on 01/25/2024 04:52 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: 32DATE:
01/25/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mental Health Program Manager II (MHPM II) Rosie Ruiz (Maduena)TIME COMPLETED:
05:30 PM
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An unannounced Case Management - Health & Safety visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Mental Health Program Manager II (MHPM II) Rosie Ruiz (Maduena). LPA stated purpose of visit & was allowed to proceed.

Physical plant toured. Sufficient furnishings & lighting throughout. Facility appeared to be clean with no overly unpleasant odors. Fire extinguisher service date: 7/12/2024. Operational Smoke & Carbon Monoxide detectors. Operational call system.
Residents observed in dining room for dinner. On this evening residents had take-out from local restaurant, not fast food. Residents appeared to like their meal. Residents appeared to be appropriately dressed & groomed.

No deficiencies issued.

Exit interview conducted with MHPM II. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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