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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206786
Report Date: 12/28/2023
Date Signed: 12/28/2023 05:57:06 PM

Document Has Been Signed on 12/28/2023 05:57 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 CENTER #4FACILITY NUMBER:
547206786
ADMINISTRATOR:LEIGH (CABEJE), TAMARAFACILITY TYPE:
735
ADDRESS:1136 S LIBERTY CTTELEPHONE:
(559) 733-6766
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
12/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator (Admin) Tamara Leigh (Cabeje)-by telephone, Mental Health Program Manager II (MHPM II) Rosie Ruiz (Maduena) & Mental Health Case Manager III Gisela AlmanzaTIME COMPLETED:
06:15 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 Mental Health Program Manager II (MHPM II) Rosie Ruiz (Maduena) & Mental Health Case Manager III Gisela Almanza.
Administrator (Admin) Tamara Leigh (Cabeje) contacted, purpose of visit stated. Admin authorized MHPM II & MHCM III to conduct visit with LPA.

Facility as licensed reviewed to verify that is correct. No changes required, including license comments. Facility grounds are comprised of 4 building total comprising campus. Each building licensed separately.

Food service provided & medication stored & dispensed at "main house" licensed as Transitional Living Center #547202809. Sufficient food available to meet residents needs. Medications & medication records maintained in locked medication room. Medications are also secured in locking carts.

Facility sufficiently furnished with items in good repair, adequate lighting in all rooms: bedrooms, bathrooms, living room, dining area. Bathroom & kitchen fixtures operational
Smoke & carbon monoxide operational. Fire extinguisher service date:7/12/23.

MHPR II authorized MHCM III to do exit interview & sign for receipt of reports.
Therefore, exit interview done with MHCM III. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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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