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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803711
Report Date: 11/18/2024
Date Signed: 11/18/2024 11:52:01 AM

Document Has Been Signed on 11/18/2024 11:52 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SYCAMORE HOMEFACILITY NUMBER:
216803711
ADMINISTRATOR/
DIRECTOR:		HOGAN,WILLIEFACILITY TYPE:
735
ADDRESS:75 JUANITA COURTTELEPHONE:
(415) 761-9790
CITY:NOVATOSTATE: CAZIP CODE:
94945
CAPACITY: 4CENSUS: 4DATE:
11/18/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator, Willie HoganTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Loera and Licensing Program Manager (LPM) Mota arrived unannounced to conduct a Case Management - Legal/Non-compliance Inspection and met with Willie Hogan, Administrator. LPA conducted a walk-through of the facility, that was found at a comfortable temperature with all exits free from obstruction. This facility was placed on non-compliance on September 6th, 2024 for a two-year term.

LPA went over compliance plan and reminded facility of the below agreement of 9/6/2024 between Community Care Licensing (CCL) and Facility, Sycamore Home.
  • Personal Rights
  • Reporting Requirements
  • Mandated Reporting
  • Inappropriate Restraints
  • Administrator Qualifications and Duties


A copy was provided to the administrator. No citations issued during todays visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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