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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209204
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:25:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2024 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240415120719
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: DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Administrator- Doderlein Anaya FernandezTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from harming themself while in care.
Staff did not safeguard resident's personal possessions.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/9/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver the findings for the allegations listed above. LPA introduced herself and explained the reason for the visit. LPA met with Administrator (AD) Doderlein Anaya Fernandez.
1. The Department investigated the allegation: Staff did not prevent resident from harming themself while in care. Multiple interviews were conducted. LPA was not able to verify facility did not prevent resident from harming themself. LPA observed bedrooms with double beds have the beds against one side of the wall.
2. The Department investigated the allegation: Staff did not safeguard resident's personal possessions. LPA conducted interviews and reviewed records. LPA observed a signed and dated "Discharge" form by R1's family indicating R1's personal possessions were returned when R1 left the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
Exit interview was conducted and a copy of this report LIC9099 was provided to Administrator.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 1