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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202809
Report Date: 04/26/2024
Date Signed: 04/26/2024 03:14:48 PM

Document Has Been Signed on 04/26/2024 03:14 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/
DIRECTOR:		LEIGH (CABEJE), TAMARAFACILITY TYPE:
735
ADDRESS:546 E. TULARE AVENUETELEPHONE:
(559) 733-6648
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 38CENSUS: 35DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Interim Administrator (IAdmin) Phillip DelgadoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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An Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Interim Administrator (IAdmin) Philip Delgado. LPA greeted IAdmin, stated purpose of visit, & was allowed to proceed with visit.

Physical plant toured. Tour started in Main House. Kitchen observed to appear to be clean, including appliances @ correct temperatures. LPA met with facility Cook & toured kitchen. Seven (7) day supply of non-perishable & 2 day supply of perishable food on the premises. LPA discussed food packaging & food calculations. Kitchen has door that can be locked to secure contents & make hazardous items such as knives inaccessible to clients. Staff have keys to kitchen to access as needed. Food storage in area opposite kitchen also accessible as needed.

Main Room - dining room / common area @ front entrance to building sufficiently furnished with adequate lighting. TV room sufficiently furnished with adequate lighting. Resident bedrooms toured. Appropriate linens available & sufficient furnishing & adequate lighting.

Tour continued to 3 apartment wings. A sampling of rooms on each wing observed. TV/living & resident bedrooms observed to have sufficient furnishings, appropriate linens available, & adequate lighting. Rooms appeared to be relatively clean.
Wellness Center toured. Sufficient furnishings & activity supplies & equipment for a multitude of activities, including movies, pool/billiards, table tennis, etc.

Continued LIC809C
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: TRANSITIONAL LIVING CENTER
FACILITY NUMBER: 547202809
VISIT DATE: 04/26/2024
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Continued from pg 1 (LIC809)

Laundry area in main house observed to have sufficient amount of cleaning supplies & linen closet observed to have a supply of linen. There is a 2nd laundry room with additional linens in apartment wing closest to Main hours.

Medication room toured. Medication observed to be stored in locked area & in locked medcarts & cabinets. Medications observed to appear organized & stored in a manner to promote organization. Medication records reviewed, MARs & CSMDR. Sample audit conducted indicating records being maintained & consistent with inventory.

Facility grounds toured. No hazards observed. Facility has designated smoking areas. Shed @ side of facility observed to be locked making contents inaccessible.
Facility smoke & carbon monoxide hard wired & maintained by same service as operational signal system. Fire extinguisher service date: 7/12/23.

Visit to be continued at a later date.

Exit interview conducted with IAdmin. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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