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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209436
Report Date: 03/08/2025
Date Signed: 03/08/2025 11:42:47 AM

Document Has Been Signed on 03/08/2025 11:42 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SYCAMORE SANDPIPERFACILITY NUMBER:
157209436
ADMINISTRATOR/
DIRECTOR:		DOYLE, VICTORIAFACILITY TYPE:
735
ADDRESS:12602 KNIGHTS BRIDGE PLACETELEPHONE:
(661) 809-6803
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
03/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:41 AM
MET WITH:Victoria DoyleTIME VISIT/
INSPECTION COMPLETED:
11:58 AM
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On 03/08/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required inspection. LPA introduced self, stated the purpose of the visit and allowed entrance by Licensee. LPA met with Administrator, Victoria Doyle and House Manager, Cynthia "Anissa" Quiroga to conduct facility inspection.

Currently, there are six (6) residents in care. Facility is a 4 bedroom, 2 bathroom home. All bedrooms are shared bedrooms. The facility was observed to be clean, well lit, odor free, and a comfortable temperature. LPA conducted facility tour with Administrator and House Manager. Resident bedrooms toured, bedrooms observed to have all required furnishings and to have linen in good repair. Additional linen supply observed available. Resident bathrooms toured, all fixtures observed to be operational, water temperature measured at 108 degrees F. Living room and dining area observed to have adequate seating available. Kitchen toured, facility observed to have 2-day supply of perishable and a 7-day supply on non-perishable food available. All sharps are locked and secured in staff room. Medications observed to be locked and secured in medication room. Medications observed to have original labels and to be administered as prescribed. All cleaning supplies observed to be locked and secured in both medication room and staff room.

Fire extinguisher was observed with a purchase date of 2/24/2025. Smoke detectors and carbon monoxide detector were tested and observed to be operational. Last fire drill conducted 3/02/2025 and last disaster drill conducted 1/09/2025.

Outside of facility toured, emergency exits open free of obstruction. Shed and storage container observed to be locked and secured. Pool is surrounded by a locked and secured gate.

Staff and resident files reviewed. LPA received copies of LIC 309 (Administrative Organization), LIC 500 (Personnel Report) and LIC 610D (Emergency and Disaster Plan) during facility inspection.

No deficiencies observed.

Exit interview conducted. A copy of this report provided to Administrator for facility records.

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2025
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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