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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209204
Report Date: 12/22/2021
Date Signed: 12/22/2021 03:48:56 PM

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:ANAYA ELDER CARE LLCFACILITY NUMBER:
247209204
ADMINISTRATOR:FERNANDEZ, DODERLEIN ANAYAFACILITY TYPE:
740
ADDRESS:2058 DANTE CTTELEPHONE:
(951) 772-9113
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:6CENSUS: 0DATE:
12/22/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Doderlein Anaya Fernandez - LicenseeTIME COMPLETED:
11:50 AM
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Licensing Program Analyst(LPA) D. Ayers arrived at the facility and met with Licensee/Administrator Doderlein Anaya Fernandez for an announced Pre-licensing Inspection. The facility fire clearance was granted six non-ambulatory.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. LPA observed smoke detectors and carbon monoxide detectors to be functional. The facility had a designated, locked cabinet for medication storage. Cleaning products and sharp items were stored in a locked drawer. LPA observed extra linens and towels. Facility had adequate amount of dishes and utensils.

The facility was adequately furnished, clean, and well-lit. LPA toured resident bedrooms and bathrooms and observed bedrooms to have required minimum furnishings. Bathrooms were clean and fixtures functioned properly. Non-skid mats and secure grab bars were observed. Outdoor area was free from hazards and had a covered patio section for seating. There were no pools or bodies of water on the property.

Licensee/Administrator completed Component III Orientation. Pre-Licensing is complete and this facility has no deficiencies. A copy of this report was provided to the licensee via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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