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Inspection visit

Follow-up on corrections

THREE SYCAMORES ON GOULDLicense 1976073551 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst(LPA) Antonia Alvizar-Ettima met with the Administrator and Assistant Administrator and an unannounced Required One (1) year inspection visit to this facility. During inspection, LPA Alvizar-Ettima discovered t he following Part-Time Staff (S1) and (S2) have been present without a Background Clearance or Transfer and Association to this facility. S1 job title is Caregiver, first day of work was 07/11/2022. S2 job title is Caregiver, first day of work was 10/18/2023. LPA request/received S1 Republika NG Pilipinas. LPA request/received S2 United States of America Permanent Resident Card. LPA verified using Guardian Background System Check, staff S1 and S2 names did not appeared on facility roster. S1- Bernadette O. Babelonia DOB: 01/12/1968 S2 - Marissa Gamboa DOB: 08/04/1969 A citation and civil penalty were issued. Copy of this report was provide to Assistant Administrator, Sean Abalajon.

Citations

2 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87355(b)(2)Type A

    All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on interview and review of Guardian Background System staff S1&S2 are not Criminal Background Clearanced or Transfer & Associated to this facility. No documentation has been submitted to CCLD. This poses a potential risk to residents in care.

  • 87608(a)(5)Type A

    87608 Postural Supports (a) ...The facility shall provide... care for the resident in those activities... unable to do for themself. Postural supports may be used ...conditions. (5) Under no circumstances shall postural supports...limiting the use of a resident's hands or feet. This requirement is not met as evidenced by. The licensee did not ensure that postural support provided to R1 is not depriving R1s’ movement. R1 was restrained to the wheelchair and had no ability to release it. This possess an immediate health and safety hazard to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the February 19, 2025 inspection of THREE SYCAMORES ON GOULD?

This was a other inspection of THREE SYCAMORES ON GOULD on February 19, 2025. 1 citation were issued: 1 Type A (serious).

Were any citations issued to THREE SYCAMORES ON GOULD on February 19, 2025?

Yes, 1 citation was issued (1 Type A, 0 Type B). The first citation was for: "All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.