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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202659
Report Date: 06/22/2021
Date Signed: 06/22/2021 12:47:57 PM

Document Has Been Signed on 06/22/2021 12:47 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:LEONIE HOUSEFACILITY NUMBER:
107202659
ADMINISTRATOR:KENDAKUR, SUNDARIFACILITY TYPE:
740
ADDRESS:2931 CAESAR AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 6CENSUS: 6DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Administrator, Sundari "Susan" KendakurTIME 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 06/22/2021, Licensing Program Analyst, (LPA) M. Garza arrived at the facility unannounced to conduct the required Infection Control Inspection. LPA was greeted by Direct Care Staff, Feliciano Galvez. LPA was screened and permitted entry into the facility. Administrator, Susan Sundari and Office Manager Jene Abragan arrived a short time later. LPA observed a central entry point with supply of hand sanitizer, sign in policy including documented routine symptom screening for resident's, staff and visitors. Residents observed in common area watching television, and in rooms.

Mitigation plan has been submitted pending approval. Staffing and sick leave plans are in place for emergency staffing and/or PPE shortages.

LPA toured the facility inside and out. Required postings of signs to include hand washing, coughing etiquette and physical distancing were observed throughout the facility. Staff observed wearing face covering. Facility has designated visitation areas. Covered trash bins were observed. LPA observed a supply of PPE and resident medications. Sinks stocked and liquid soap for hand washing and paper towels for hand drying were observed.

Through LPA observation of documentation and interview with Administrator and staff, the required infection control practices are found to be in compliance. No deficiencies issued during todays inspection. Exit interview completed with Administrator.

A copy of this report was sent via email for signature. A delivered and read receipt was sent as confirmation of receipt.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2021
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