Senior Care Records.

Facility Evaluation Report

Sycamore Home, San Martin09/24/2024Licence 435202728

Capacity4
Census4
Date signed09/24/2024 03:56:52 PM
The inspector’s account

Licensing Program Analyst (LPA) Maria (Mita) Partoza a conducted an unannounced required 1 year inspection visit and met with Director of Operations (DO) David Sandhu and Noel Huante (ADM) and stated the purpose of the visit.

The facility is licensed to serve adults. 18 to 59 4 ambulatory only. The License is subject to the terms and conditions for hospice care for two (2) LPA observed 3 out of 4 residents (R2 to R4) are present at the facility that have neurocognitive impairment. 1 out of 4 is in the day program (R1) There are 6 staff present at the time of the visit.

At 10:48 a.m. LPA toured the facility inside and outside with DO and ADM, including but not limited to the kitchen, bathroom, dining room, living room, 4 out of 4 residents rooms, garage, backyard and exterior walkways. The temperature inside the home was at 73 degrees Fahrenheit.

The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. Under the sink cabinet is kept locked and not accessible to residents. The water temperature measured at 115.7 degrees Fahrenheit.

The facility is maintained, sanitary and organized. Based on the Department of Developmental Services (DDS) audit on 9/10/2024. The following were addressed and inspected during today's visit. The facility's lacks window screen, ADM reported that due to one of the resident (R2) consistently rips the screens off the window. ADM stated that they will get a flexible screens that does not break easily and will be placed on the windows. Currently ADM has a magnetic screen window instead a permanent one.

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