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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803711
Report Date: 03/13/2025
Date Signed: 03/13/2025 04:15:19 PM

Document Has Been Signed on 03/13/2025 04:15 PM - 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: 3DATE:
03/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:55 PM
MET WITH:Licensee, Marisol Hogan TIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 03/13/2025 Licensing Program Analyst (LPA) Loera met with Licensee, Marisol Hogan for a Case Management, Regional Office meeting to follow up on substantiated complaint allegations; complaint number 21-AS-20240514220121.  

On September 6, 2024, the Department concluded an investigation which alleged that a staff physically abused a client while in care resulting in injury and that staff did not properly report an incident involving a client.

The licensee was cited for violating California Code of Regulations (CCR) Title 22, § 80072(a)(3) Personal Rights and California Code of Regulations (CCR) Title 22, § 80061(b)(1)(E) Reporting Requirements.

At the time of the complaint visit on September 6, 2024, the licensee was informed that a civil penalty might be assessed based on Health and Safety Code § 1548(f)(1)(A).

The Department has concluded an analysis and has determined that a civil penalty is warranted for physical abuse. The Welfare and Institutions Code Section 15610.63 for physical abuse includes the following: Assault, as defined in Section 240 of the Penal Code and Battery, as defined in Section 242 of the Penal Code. This is evidenced by the Licensee not ensuring the safety of a client (C1) which resulted in them being physically abused by staff. C1 was observed with bruising around the throat and diagnosed with “strangulation or suffocation.”

Today, 03/13/2025 the Department is issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as physical abuse in the amount of $10,000.



A copy of the LIC 421D was given to Licensee, Marisol Hogan and originals were signed.

Exit interview conducted. A copy of the report issued. Appeal rights provided. (Facility representative) signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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