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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209204
Report Date: 12/15/2023
Date Signed: 12/18/2023 07:23:04 AM


Document Has Been Signed on 12/18/2023 07:23 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
SIERRA CASCADE AC/SC, 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: 3DATE:
12/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administrator- Doderlein Anaya FernandezTIME COMPLETED:
04:30 PM
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On 12/15/23 at 11:58 a.m. Licensing Program Analyst (LPA) B. Miranda entered the facility. LPA arrived at the facility unannounced to conduct an unannounced annual inspection. LPA met with Administrator (AD) D. Anaya Fernandez.

Upon entering the facility LPA observed 2 residents in the living room watching TV and 1 resident in their room.

Facility has 4 bedrooms and 2.5 bathrooms available for residents. The facility has a capacity of 6 and there are currently 3 residents living at the facility. Facility has live in staff at the facility. 2 of the 3 residents share a room and the 3rd resident has a private room. LPA observed staff and residents interacting with one another.

LPA toured the facility inside and out. Facility is clean, odor free, and clear from obstruction. LPA observed knives/sharps, disinfectants, and chemicals to be locked and inaccessible to residents.

LPA observed exits to be free from obstruction. Water temperature was check in a bathroom and read at 111.6 degrees F. LPA observed fire extinguisher to be services 11/29/23 and in good standing. Smoke detector and carbon monoxide reader was tested and is in good standing.

LPA observed residents rooms to be properly furnished. LPA observed resident files and a sample of staff files.

LPA observed resident's medications.

No citations were issued at this time.

Exit inter was conducted and a copy of this report LIC809 was provided to AD.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023
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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