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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201592
Report Date: 07/24/2024
Date Signed: 07/29/2024 03:40:10 PM

Document Has Been Signed on 07/29/2024 03:40 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/
DIRECTOR:
KENDAKUR, SUNDARIFACILITY TYPE:
740
ADDRESS:2508 BARSTOW AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 5DATE:
07/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Care Coordinator Shannon SteeleTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 07/24/24 Licensing Program Analysts (LPA) M. Yang and J. Leffall arrived unannounced to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and was greet by staff Jonard Stu Ana. Administrator Sundari Kendakur was called. Care Coordinator (CC) Shannon Steele arrived shortly. All 5 residents were present during inspection.

LPAs toured facility with CC. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 40 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Medications were checked and observed kept locked in kitchen shelves. LPAs observed MARs and medications. Sharps were observed stored and locked in kitchen shelf. Fire extinguisher was observed with a service date of: 07/02/24. Residents' 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 range between 105.4 and 105.3 degrees F. in master bathroom and 106.3 in bathroom 1. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Carbon monoxide and smoke detectors were tested and observed to be operational. All residents’ file and a sample of staff files were reviewed to have all the required documents.

No deficiencies issued during this inspection.


Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 07/30/24: Lic 308, Lic 500, Lic 610E, current liability insurance, and current Administrator Certificate. A copy of this report was provided to Care Coordinator, whose signature on this form confirms receipt of these report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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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