<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201592
Report Date: 08/14/2023
Date Signed: 08/14/2023 12:52:50 PM


Document Has Been Signed on 08/14/2023 12:52 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:ANJALI HOUSEFACILITY NUMBER:
107201592
ADMINISTRATOR:KENDAKUR, SUNDARIFACILITY TYPE:
740
ADDRESS:2508 BARSTOW AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 5DATE:
08/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Designee Luijean “Jean” De Castro TIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/14/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA met with staff Annie Togonon. LPA introduce self, stated the purpose of the visit and request to met with Administrator Sundari “Susan” Kendakur. Administrator was called and stated unable to attend meeting. Designee Luijean “Jean” De Castro arrived shortly and conducted tour with LPA. All five residents were present during inspection.

The tour started in the kitchen into the common areas, to the resident's bedrooms, and bathrooms. The facility was observed to be at a comfortable temperature of 77 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Temperature maintained for refrigerator at 40 degrees F and freezer at 0 degrees F. Cleaning supplies and chemicals stored and locked under kitchen sink and in garage cabinet. Medications observed kept locked in kitchen shelf. MARs were reviewed. Fire extinguisher was observed with a service date of: 06/08/23. Fire drill last completed:05/10/23.All bedrooms were observed to have required furnishings and with adequate lightening. LPA observed 1 vacant bedroom, two single occupant bedroom and 1 shared bedroom. Bathrooms were properly equipped, and the hot water temperature was tested at 117.4 degrees in bathroom 1 and range between 113.7 degrees F and 115 degrees F in shared bathroom. First Aid kit observed with all required documents.Outside of facility toured and observed to be free of debris. Adequate outside seatings observed available for residents. Side gate observed self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have update emergency contacts, Admission agreement, and Pre-Appraisal. All staffs’ files were also reviewed. All staff files were observed to have current First Aid/CPR, fingerprinted clear and associated to the facility.



No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 08/21/23. Forms requested: Lic 308, Lic 500, Lic 610E, current liability insurance and current Administrator certificate. A copy of this report was provided to designee, whose signature on this form confirms receipt of this report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1