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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202728
Report Date: 04/03/2025
Date Signed: 04/03/2025 09:21:01 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2025 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20250123225341
FACILITY NAME:SYCAMORE HOMEFACILITY NUMBER:
435202728
ADMINISTRATOR:NOEL HUANTEFACILITY TYPE:
737
ADDRESS:15160 SYCAMORE AVETELEPHONE:
(408) 915-5970
CITY:SAN MARTINSTATE: CAZIP CODE:
95046
CAPACITY:4CENSUS: 4DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lead Staff Jeanette AguilarTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Resident(s) was/were observed neglected and unsupervised entering a neighbor's property, and running down the streets naked in the neighborhood.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with lead staff Jeanette Aguilar. LPA spoke with Administrator (ADM) Noel Huante. ADM stated she was driving to the facility. ADM stated her lead staff,Jeanette Aguilar, could sign on her behalf.

On January 23, 2025, the Department received a complaint alleging Resident(s) was/were observed neglected and unsupervised entering a neighbor's property and running down the streets naked in the neighborhood. It has been alleged a resident entered a neighbor’s property, on an unspecified date.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 26-AS-20250123225341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: SYCAMORE HOME
FACILITY NUMBER: 435202728
VISIT DATE: 04/03/2025
NARRATIVE
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On January 28, March 21 and April 1, 2025, the Department interviewed staff S1-S11. Staff S1-S3 and S8 stated they are unaware of any incidents of residents eloping from the facility. Staff S4, S6 and S7 stated they are aware of an elopement that occurred when R1 jumped over a fence. (This elopement is being investigated under a separate complaint investigation: 26-AS-20220913094545). Staff S5, S9-S11 stated they are aware that R1 eloped from the facility on 2 different occasions but don’t know the details. Staff S1-S11, stated they have not seen a resident running in the streets naked.

Staff S6 stated the was an elopement that occurred on May 29, 2023, where R1 trespassed onto a neighbor’s property at 11:50am. S6 stated this elopement occurred without staff supervision.

The Department interviewed residents R1-R4. All residents interviewed were unable to provide answers to LPA's questions. Residents interviewed had behaviors such as, but not limited to; not talking or responding to questions LPAs posed/ continuing to watch/play on their iPad/television.

Licensing Program Analyst Manuel Monter interviewed ADM. ADM stated she wasn’t at the facility when the elopement occurred on May 29, 2023. ADM stated she only knows what was reported to her and what was written on the incident report. ADM stated the facility did implement changes outlined in the incident report.

On April 1, 2025, LPA Manuel Monter interviewed witnesses W1 and W2. W1 stated he/she has not observed residents eloping from the facility. W2 stated he/she is aware of incidents were R1 eloped from the facility a few years ago but couldn’t provide details. W1 and W2 stated they have not seen residents running in the street naked.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 26-AS-20250123225341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: SYCAMORE HOME
FACILITY NUMBER: 435202728
VISIT DATE: 04/03/2025
NARRATIVE
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Based on a review of facility incident report (IR), dated May 29, 2023, R1 at approximately 11:50, was in his/her bedroom. R1 began to engage in private time. Staff proceeded to give R1 privacy in his/her bedroom. At Approximately 12:00, the facility got a knock on the door from neighbors, accompanied by R1. The IR stated the neighbors communicated that R1 trespassed on their property and that they contacted 911. Neighbors stated they wanted to make sure R1 was home safe.

Based on a review of R1’s Individual Program Plan (IPP), dated June 13, 2022, under safety skills/disaster preparedness: “R1 has very limited safety skills and requires constant supervision…R1 does not have street safety or stranger danger skills…if he sees something that is interesting to him/her, he/she may wander off to explore.” R1’s IPP also states on page 13, “Staff will provide care and supervision of behaviorally related events and provide redirection…”

Based on a review of R1’s Physician’s Report, dated June 13, 2023, resident R1 cannot leave the facility unassisted.

The Department has investigated the above allegation. Based on records reviewed, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED.

As a result, the Department issued an immediate civil penalty of $500 for a violation of absence of supervision, which resulted in R1 eloping from the facility.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D. This report was reviewed with Administrator Noel Huante, via phone call. ADM stated her lead staff, Jeanette Aguilar could sign on her behalf. A copy of the report was provided. Appeal Rights was provided.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 26-AS-20250123225341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SYCAMORE HOME
FACILITY NUMBER: 435202728
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2025
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement was not met as evidence by:
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ADM stated to submit a Plan of Correction by the POC due date on how she will ensure residents who cannot leave the facility unassited are supervised, to ensure the facility is meeting the supervision necessary to meet the resident’s needs.
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Based on interviews conducted and records reviewed, resident R1 eloped from the facility on May 29, 2023, and facility staff were unaware. This poses an immediate health, safety or personal rights risk to persons in care.
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ADM stated she will submit the written plan of action to LPA by POC date, April 4, 2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
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