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Facility Evaluation Report

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

Capacity6
Census3
Date signed02/19/2025 05:37:28 PM
The inspector’s account

Licensing Program Analyst(LPA) Antonia Alvizar-Ettima met with the Administrator and Assistant Administrator and an unannounced Required One (1) year inspection visit to this facility.

During inspection, LPA Alvizar-Ettima discovered t he following Part-Time Staff (S1) and (S2) have been present without a Background Clearance or Transfer and Association to this facility. S1 job title is Caregiver, first day of work was 07/11/2022. S2 job title is Caregiver, first day of work was 10/18/2023.

LPA request/received S1 Republika NG Pilipinas. LPA request/received S2 United States of America Permanent Resident Card. LPA verified using Guardian Background System Check, staff S1 and S2 names did not appeared on facility roster.

S1- Bernadette O. Babelonia DOB: 01/12/1968

A citation and civil penalty were issued. Copy of this report was provide to Assistant Administrator, Sean Abalajon.

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