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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206791
Report Date: 12/05/2024
Date Signed: 12/05/2024 01:07:00 PM

Document Has Been Signed on 12/05/2024 01:07 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:TRANSITIONAL LIVING CENTER #3FACILITY NUMBER:
547206791
ADMINISTRATOR/
DIRECTOR:
LEIGH (CABEJE), TAMARAFACILITY TYPE:
735
ADDRESS:1142 S LIBERTY CTTELEPHONE:
(559) 733-6765
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 3CENSUS: 3DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Administrator: Veronica CliftonTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 12/5/24 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Administrator (A1) Veronica Clifton. LPA was granted entry. 3 clients were present during visit.

LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at 1 degrees F and refrigerator temperature was maintained at 40 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 7/24/24. Fire drill completed on 12/3/24. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested 118.5 degrees F in bathroom 1 and 118.9 degrees F in bathroom 2. Outside of facility toured. The back area is an open area that does not contain a backyard gate. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication room in main office. Clients’ MARS was reviewed.

Carbon monoxide and smoke detectors were tested and observed to be operational. Staff files reviewed. 1 required form missing from 1 staff file. Client files were reviewed to have all required documents.



No deficiencies issued during this inspection. A Technical Violation issued for missing staff document.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 12/19/24: Lic 308, Lic 500, Lic 610D, Lic 9020 and Administrator Certificate. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of these reports.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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