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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209565
Report Date: 01/27/2025
Date Signed: 01/28/2025 09:39:36 AM

Document Has Been Signed on 01/28/2025 09:39 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 HEALTHCARE, BAKERSFIELDFACILITY NUMBER:
157209565
ADMINISTRATOR/
DIRECTOR:
DOYLE, VICTORIAFACILITY TYPE:
735
ADDRESS:7208 ANGELA AVETELEPHONE:
(661) 326-8104
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 6CENSUS: 6DATE:
01/27/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:23 PM
MET WITH:Victoria Doyle, Administrator LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:52 PM
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On 01/27/25, Licensing Program Analysts (LPAs) L. Salazar and M. Medina arrived to the facility for an announced Pre-licensing (Change of Location) inspection. LPA met with Licensee and Administrator. No residents were present at the time of LPA's visit.

LPA toured of the facility inside and out with Administrator. Facility is observed to be a 3 bedroom / 3 bathroom house. Common areas were observed to be clean, spacious. Blue tape was outlined in the areas where the furniture will be placed on the day of the relocation. Facility was well-lit throughout. Carbon monoxide and smoke alarm detectors were installed and operational. Cleaning and chemical supplies were observed locked in the garage. Facility’s temperature read 68 degrees F. Fire extinguisher observed in the kitchen with a service date of 01/14/24. Washer and dryer observed in the laundry room with additional storage space available. Doors and passageways are clear and free from obstruction throughout the home. A fully gated pool was observed to be locked. Patio was observed to be covered, with lights installed. A separate covered seating area was observed for smoking.

Resident’s bedrooms were observed to be adequately furnished with bed, night stand, drawer space, chair and adequate lighting. Mattresses and linen were in good condition. Extra linen are available in the hallway closet. Hand soap, paper towels, and trash cans with tight fitting lids were observed. Water temperature measured at 107 degrees F.

First aid kit observed to have required items. Once relocated, medications will be locked in the hallway closet. Appliances observed to be in working order. LPAs observed food storage and preparation areas to be clean and appropriate for food preparation. A sample menu of 7 days was observed posted. Emergency disaster and Infection control plan were observed to be complete.

Component III was completed, an exit interview was conducted with Licensee and Administrator. LPA Salazar will contact Central Applications Bureau and advise the facility is ready for Change of Location licensing.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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