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Inspection visit

Routine inspection

THREE SYCAMORES ON GOULDLicense 197607355
Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Assistant Administrator and Administrator and explained the reason for the visit. Administrator, Yule indicated not being able to stay for today’s visit and authorized Assistant Administrator to sign the report. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: At 10:05p.m. a tour of the physical plant was conducted. There is only one entrance being utilized at the facility. Living and dining room furniture were checked. The living room is neat and clean. The dual carbon/smoke detectors are interconnected and observed to be operational. Fire extinguishers with service date of 01/03/2025 are located thorough out the facility. The facility has five (05) bedrooms and three (03) bathrooms currently occupying three (03) residents. Three (03) rooms are private room and two (02) rooms are empty. The backyard of the facility has outdoor furniture with a covered shaded area for residents. There is no body of water at the facility. There is also a shed at the backyard. Laundry area is located next to detached garage, laundry detergents, cleaning agents and other toxins were observed to be locked. Food Service/Kitchen area was sufficiently stocked with two (02) days of perishable and seven (07) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. Cont. on LIC 809-C Residents rooms are adequately furnished with appropriate furniture and lighting system. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the shower and toilet. The hot water temperature was measured at 111.8 degrees. There was enough clean linen available in stock at the cabinet. LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. There are two (02) complete first aid kit. Resident Files: A file review of resident records to insure compliance of licensing forms. Staff Files: A file review of staff records to insure forms and training are up to date and compliance with licensing forms. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit. Exit Interview Conducted / A Copy of the Report was provided 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 inspection inspection of THREE SYCAMORES ON GOULD on February 19, 2025. The inspection found no deficiencies and no citations were issued.

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

No citations were issued during this inspection. The facility was found to be in compliance with all applicable regulations.

What type of inspection was this?

This was a inspection inspection. inspection 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.