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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208245
Report Date: 12/05/2024
Date Signed: 12/05/2024 10:39:17 AM

Document Has Been Signed on 12/05/2024 10:39 AM - 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 #2FACILITY NUMBER:
547208245
ADMINISTRATOR/
DIRECTOR:
LEIGH (CABEJE), TAMARAFACILITY TYPE:
735
ADDRESS:1108 E LIBERTY CTTELEPHONE:
(559) 733-6739
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 10CENSUS: 0DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Program Supervisor-Veronica CliftonTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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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. 0 clients are currently not placed in facility.

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. No food was observed in refrigerator or freezer because of no residents in facility. Freezer temperature was maintained at 5 degrees F and refrigerator temperature was maintained at 35 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 currently not conducted because of vacancy of residents in facility. 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 113.9 degrees F in bathroom 1 and 118 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 not present in facility because of vacancy. Facility does have a Centrally Stored Medication Record designation in locked closet.

Carbon monoxide and smoke detectors were tested and observed to be operational. No clients’ file reviewed because of vacancy in the facility. No staff files were reviewed as facility does not currently have staff.



No deficiencies issued during this inspection.

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 Administrator, whose signature on this form confirms receipt of this report.

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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