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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201592
Report Date: 07/26/2021
Date Signed: 07/26/2021 10:07:03 AM

Document Has Been Signed on 07/26/2021 10:07 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
CCLD Regional Office, 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: 55DATE:
07/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:Sundari KendakurTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) M. Medina conducted an unannounced Infection Control Inspection on this date. LPA Medina allowed entrance by Direct Care Staff. Administrator, Sundari Kendakur arrived a short time later to conduct inspection.

LPA observed a central entry point with a supply of hand sanitizer and a sign in policy that includes documented routine symptom screening for resident's, staff and visitors.

Infection control procedures observed by LPA include: Daily symptoms screenings for staff, persons in care and visitors, visitation policy, and quarantine/isolation procedures. Facility has adequate Personal Protective Equipment (PPE) available which includes, gowns, gloves, hand sanitizers, N-95 and face shields. Facility has a binder for COVID for procedures, documentation, postings and communication.

LPA toured the facility inside and out. Facility observed to be clean and odor free. Food supply is adequate for resident's in care. Resident bedrooms toured. Bathrooms have signs for hand washing. Staff were all observed wearing face coverings. LPA observed a 30-day supply of resident medications. Fire extinguisher has a service date 05/07/2021, carbon monoxide and smoke detectors present and observed operational during today's inspection.

LPA observed the required infection control practices are found to be in compliance. Sundari Kendakur, Administrator Certificate #6019761740, expires 8/26/2022. LPA received an email copy of Administrator certificate during facility visit.

No deficiencies cited during today’s inspection.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2021
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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