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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208245
Report Date: 12/28/2023
Date Signed: 12/28/2023 05:58:45 PM

Document Has Been Signed on 12/28/2023 05:58 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 #2FACILITY NUMBER:
547208245
ADMINISTRATOR:LEIGH (CABEJE), TAMARAFACILITY TYPE:
735
ADDRESS:1108 E LIBERTY CTTELEPHONE:
(559) 733-6739
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 10CENSUS: 0DATE:
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.

Currently there are no clients residing in facility.

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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