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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202809
Report Date: 07/19/2024
Date Signed: 07/22/2024 09:25:56 AM

Document Has Been Signed on 07/22/2024 09:25 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, 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: DATE:
07/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Mental Health Case Manager II (MHCM II) Jordan Eala; Interim Administrator (IAdmin) Phillip Delgado by telephone;TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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An unannounced Case Management - Other visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Mental Health Case Manager II (MHCM II) Jordan Eala; LPA greeted MHPM II, stated purpose of visit, & was allowed to proceed with visit. LPA then called Interim Administrator (IAdmin) Phillip Delgado by telephone to let IAdmin know that licensing was on the premises, the purpose of visit, & to review contents of report. IAdmin verbally authorized MHCM II to sign report.

The purpose of this visit was to document concerns from 7/17/24 visit, including, but not limited to, in no particular order:

Health Related Services
Personnel Requirements
Personnel Records
Reporting Requirements
Administrator Qualifications & Duties

Citations issued during 7/17/24 Complaint visits along with additional concerns will be reviewed at an Office meeting to be held at the Fresno Regional Office. Presence of Licensee/Licensee's representative is required.



Office meeting date & time to be determined. Licensee will be contacted by the Department.

No deficiencies @ this time.

Exit interview conduced with MHCM II. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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