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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209436
Report Date: 03/14/2024
Date Signed: 03/14/2024 11:33:08 AM

Document Has Been Signed on 03/14/2024 11:33 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SYCAMORE SANDPIPERFACILITY NUMBER:
157209436
ADMINISTRATOR:DOYLE, VICTORIAFACILITY TYPE:
735
ADDRESS:12602 KNIGHTS BRIDGE PLACETELEPHONE:
(661) 809-6803
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 0DATE:
03/14/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Victoria DoyleTIME COMPLETED:
11:46 AM
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On 03/14/2024, Licensing Program Analyst (LPA) Walton arrived for an announced pre-licensing inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Victoria Doyle. This facility is being licensed as a change of location.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. Fire extinguisher was observed with a purchase date of 01/24/2024. Smoke detectors and carbon monoxide detector were tested and observed to be operational. The First Aid Kit will be transferred once license is obtained and residents are relocated. Medication and cleaning supplies will be kept in a room near the laundry area. Knives/Sharps will be kept in the facility office/staff room.

Residents' bedrooms were observed to have required furnishings and adequate lightning. Mattresses and box springs were in good condition. A sufficient supply of linens was observed. Bathrooms were properly equipped. Hot water was tested at 112.6 degrees F in the resident bathroom. There is a covered patio area outside the facility. A self-latching gate was also observed. Required postings were observed. Per Administrator, the washer/dryer will be transferred once license is obtained and residents are relocated.

LPA has found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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