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Inspection visit

Routine inspection (multi-day)

THREE SYCAMORES ON GOULDLicense 1976073558 citations on this visit
8 citations recorded

Inspector’s narrative

What the inspector wrote

At 11:10a.m. Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection continuation to this facility. LPA met with Caregiver and granted entry to the facility. Caregiver called Assistant Administrator via-phone. At 11:35a.m. Assistant Administrator joined the visit and explained the reason for the visit. Administrator, Yule indicated not being able to joined today’s visit and authorized Assistant Administrator to sign the report. Deficiencies observed on 02/19/2025 visit as follow: -The licensee failed to follow their own plan of operation. The facility retains two (02) hospice residents, but hospice waiver is approved for one (01) resident. - Licensee did not ensure that the facility is in good repair. Facility retains dementia residents and one of the gates leading outside was broken. -Licensee did not ensure that facility temperature is comfortable for all residents. Thermostat was broken for a while and the rooms were heated by portable heaters. - Licensee did not ensure that outdoor passageways are free of obstruction. There are several pieces of lumber with sharp edges leaning against back wall of the facility. -Upon review of residents records, LPA noted that the documents on the records identify other facilities names. Physician reports were not signed by the doctors. -Licensee did not ensure that the facility is free of vermin. -Licensee did not ensure that the facility has qualified Administrator that could confirm applicable law, rules and regulations. - Facility retains two (02) hospice residents but is approved for 1 hospice waiver. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit.

Citations

8 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.

  • 1569.1(a)(1)Type A

    Based on interview, the licensee did not comply with the section cited above facility retains two (02) hospice residents. Hospice waiver is approved for one (01) resident which poses a potential health, safety or personal rights risk to persons in care.

  • 7506(a)Type B

    Based on record review, the licensee did not comply with the section cited above documents on the records identify other facilities names. Physician reports were not signed by the doctors which poses an immediate health, safety or personal rights risk to persons in care.

  • 87208Type A

    Based on record review, the licensee did not comply with the section cited above facility retains two (02) hospice residents, but hospice waiver is approved for 1. This possess an immediate health and safety hazard to clients in care.

  • 87303(a)Type A

    Based on observation, the licensee did not comply with the section cited above licensee did not ensure that the facility is in good repair. Facility retains dementia residents and one (01) of the gates leading outside was broken. This possess an immediate health and safety to residents in care.

  • 87303(b)Type A

    Based on observation, the licensee did not comply with the section cited above the thermostat was broken for a while and the rooms were heated by portable heaters which poses an immediate health, safety or personal rights risk to persons in care.

  • 87307(d)(6)Type A

    Based on observation, the licensee did not comply with the section cited above there are several pieces of lumber with sharp edges leaning against back wall of the facility which poses an immediate health, safety risk to persons in care.

  • 87405(d)(2)Type B

    Based on record review, the licensee did not comply with the section cited above that the facility has qualified Administrator that could confirm applicable law, rules and regulations. Facility in noncompliance with title 22 regulations leading to serious deficiencies which poses a potential health, safety or personal rights risk to persons in care.

  • 87555(27)Type B

    Based on observation, the licensee did not comply with the section cited above LPA was informed that there are rat droppings in the facility which poses a potential health, safe risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the February 21, 2025 inspection of THREE SYCAMORES ON GOULD?

This was a other inspection of THREE SYCAMORES ON GOULD on February 21, 2025. 8 citations were issued: 5 Type A (serious) and 3 Type B.

Were any citations issued to THREE SYCAMORES ON GOULD on February 21, 2025?

Yes, 8 citations were issued (5 Type A, 3 Type B). The first citation was for: "Based on interview, the licensee did not comply with the section cited above facility retains two (02) hospice residents..."

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.