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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209204
Report Date: 12/26/2024
Date Signed: 12/26/2024 12:44:28 PM

Document Has Been Signed on 12/26/2024 12:44 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ANAYA ELDER CARE LLCFACILITY NUMBER:
247209204
ADMINISTRATOR/
DIRECTOR:		FERNANDEZ, DODERLEIN ANAYAFACILITY TYPE:
740
ADDRESS:2058 DANTE CTTELEPHONE:
(951) 772-9113
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 6CENSUS: 3DATE:
12/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Doderlein Fernandez - AdministratorTIME VISIT/
INSPECTION 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 12/26/24 Licensing Program Analyst (LPA) M Vega entered the facility. LPA arrived at the facility unannounced to conduct an unannounced annual inspection. LPA met with Assistant Administrator Kirstenkay Kaye Yu and also Administrator (AD) Doderlein Anaya Fernandez.

Facility has 4 bedrooms and 2.5 bathrooms. 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. 1 of the 3 residents are in a share a room and the other 2 residents have a private room each.

Upon entering the facility LPA observed residents 2 residents in common area watching TV, 1 resident with their family for the holidays. The facility was observed to be at a comfortable temperature, of 75 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. Department phone number and infection prevention information signs were posted in facility. LPA observed residents rooms to be properly furnished.



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. Kitchen LPA observed the required 7 day supply of non-perishable food and 2 day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

LPA observed water temperature in a main resident bathroom and read at 107.4 degrees F. LPA observed fire extinguisher to be services 11/22/24 and in good standing. Smoke detector and carbon monoxide reader was tested and is in good standing.

LPA toured facility with Administrator outside. LPA observed no external bodies of water. Outdoor seating area was observed in good repair and available to residents.


Continuation on LIC 809C

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: ANAYA ELDER CARE LLC
FACILITY NUMBER: 247209204
VISIT DATE: 12/26/2024
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
26
27
28
29
30
31
32
LPA observed resident's medications. LPA observed resident files and staff files complete. Resident files observed to have updated information. An emergency disaster plan was observed.


No deficiencies were observed and cited. Exit interview conducted.
Report was signed and copy of this report was provided for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2