Senior Care Records.

Facility Evaluation Report

Three Sycamores on Gould, La Canada02/19/2025Licence 197607355

Capacity6
Census3
Date signed02/19/2025 05:33:52 PM
The inspector’s account

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Assistant Administrator and Administrator and explained the reason for the visit. Administrator, Yule indicated not being able to stay for today’s visit and authorized Assistant Administrator to sign the report.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

At 10:05p.m. a tour of the physical plant was conducted. There is only one entrance being utilized at the facility. Living and dining room furniture were checked. The living room is neat and clean. The dual carbon/smoke detectors are interconnected and observed to be operational. Fire extinguishers with service date of 01/03/2025 are located thorough out the facility.

The facility has five (05) bedrooms and three (03) bathrooms currently occupying three (03) residents. Three (03) rooms are private room and two (02) rooms are empty.

The backyard of the facility has outdoor furniture with a covered shaded area for residents. There is no body of water at the facility. There is also a shed at the backyard.

Laundry area is located next to detached garage, laundry detergents, cleaning agents and other toxins were observed to be locked.

Food Service/Kitchen area was sufficiently stocked with two (02) days of perishable and seven (07) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction