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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202809
Report Date: 02/13/2025
Date Signed: 02/13/2025 06:46:09 PM

Document Has Been Signed on 02/13/2025 06:46 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 AVETELEPHONE:
(559) 733-6648
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 38CENSUS: DATE:
02/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:15 PM
MET WITH:Behavioral Health Case Manager III (BHCM-3) Jordan EalaTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
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During an unannounced Complaint visit Licensing Program Analyst (LPA) K. McClurg met with Behavioral Health Case Manager III (BHCM-3) Jordan Eala.

Medications & records required to be on file & maintained at facility according to Title 22 were reviewed during this visit.
The following items & how they relate to Title 22 were included in discussion:
  • Centrally Stored Medication & Destruction Records (CSMDR) for house PRN on file for OTC medications.
  • PRN maintenance & record keeping for all PRN, including house OTC medications.
  • Options & ideas regarding simplified, but accurate documentation for all PRNs.
  • Medication/Client Record keeping & maintenance.
  • Client Records, information on file & maintained as required by Title 22;
  • Review of maintenance & requests for physicians orders for all PRNs including OTCs.
  • Possible options & troubleshooting regarding medication tracking & required documentation specifically for PRNs & OTC PRNs.

Discussion at time of visit was informational only & not a response to violations.

Exit interview conduced with BHCM-3. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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