547202809-10-6-2023-24-AS-SMOA-CWSRMS-20231020130914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547202809
Report Date: 10/06/2023
Date Signed: 10/06/2023 06:22:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2023 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20230608162916

FACILITY NAME:	TRANSITIONAL LIVING CENTER		FACILITY NUMBER:	547202809
ADMINISTRATOR:	LEIGH (CABEJE), TAMARA		FACILITY TYPE:	735
ADDRESS:	546 E. TULARE AVENUE		TELEPHONE:	(559) 733-6648
CITY:	VISALIA	STATE: CA	ZIP CODE:	93292
CAPACITY:	38	CENSUS: 30	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Administrator (Admin) Tamara Leigh-by telephone; Mentail Health Case Manager III (MHCMIII) Michelle Terry		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Resident was pushed while in care.
Resident is engaging in physical altercations while in care.

INVESTIGATION FINDINGS:

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A Complaint visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Mentail Health Case Manager III (MHCMIII) Michelle Terry. LPA spoke with Administrator (Admin) Tamara Leigh-by telephone & authorized MHCMIII to sign for receipt of reports.

The Department conducted interviews with staff and reviewed records. Incident report was submitted to the CCL office. Staff interviewed denied that resident was pushed or engaged in a physical altercation. Incident report states that staff intervene before an altercation occurred. Based on interviews conducted and records reviewed, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated.

Exit interview was conducted with MHCMIII. Report provided.

Unsubstantiated

Estimated Days of Completion:

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.

LIC9099 (FAS) - (06/04)

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