Sycamore Canyon Assisted Living and Memory Care

Type of visit: Case Management - Deficiencies

On 5/26/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint investigation into complaint control number 18-AS-20260520083842. During the visit, LPA Flores observed health and safety concerns which is summarized as follows: During an interview with Resident #1 (R1), LPA Flores was granted entry into R1's bedroom. Upon entry, LPA smelled a strong odor of urine coming from R1's bedroom. LPA observed a heavily soiled brief laying on the floor near R1's bed frame. R1 had a white cloth laying on the floor which was observed to have urine stains. R1 was observed to have a soiled brief that can be described as hanging low on R1's body. A records review conducted of R1's physician reports divulged that R1 requires assistance with incontinence care. Interviews with Staff #1 (S1) reports that R1 does not require assistance with brief changed and can toilet independently. Interviews with R1 reports that they require assistance but staff are busy. Therefore, deficiencies will be issued in accordance to Title 22 Regulations 87625(b)(3). An exit interview was conducted and a copy of this report was provided to the Administrator Zay Choudry.the state’s words, verbatim · CDSS document, May 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Jun 9, 2026

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met with evidence by: (1) One out of (4) four residents were not reeiving the incontinence care needed as reported in their medical assessment which poses a potential health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: Administrator agreed to conduct an in-service training covering Title 22, Section 87625 Managed Incontinence along with creating an incontinence check log which will cover regular checks staff have done within appropriate period of time. The incontinence care log will be ongoning with no set POC date. The Managed Incontinence training will have a set POC date of 6/9/2026 by close of business. Proof will be submitted to LPA via email.

Type of visit: Required - 1 Year

On 3/16/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required visit. LPA Flores met with staff Rosa Rangel and explained the purpose of the visit. LPA Flores was granted entry into the facility and a tour of the facility was conducted alongside Rosa. LPA observed the following during the tour: The facility is a single-story structure which consisted of (4) four resident bedrooms, (3) three bathrooms, living room, formal dining room, kitchen, laundry room, garage and gated backyard. Indoor and outdoor passageways were free from obstruction. LPA observed an covered outdoor patio that was furnished. LPA observed an empty fountain located in the backyard. Resident bedrooms were observed to be equipped with the required bedding, furniture, and functional lighting. The hallways to the non-private bathrooms were equipped with night lights. Shower and toilet areas were equipped with grab bars. Showers maintained slip resistant materials. LPA observed board games and other activities stored in the living room. Kitchen area was observed to be organized and sanitary. The facility maintained a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. Water measured within the required limits. Carbon monoxide and smoke detectors were observed to be fully operable. Linen and towels were observed to be sufficient in supply and in good quality. Medication was observed to be centrally stored in a locked cabinet. Facility provided laundry services on-site. The washer and dryer were observed to be in good repair. Cleaning detergents and disinfectants were kept in a locked cabinet, inaccessible to residents. Emergency food and water were observed in the garage. Per Administrator, there are no firearms and/or ammunition on the premises. (Continue to LIC809C) (Continuation from LIC809) LPA conducted resident records review for (5) five out of (5) five residents. Resident records included but not limited to identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, pre-placement appraisals, functional capabilities, and personal rights notification. LPA conducted (2) two staff records review. Records included but not limited to health screenings, personnel records, fingerprint clearance, background clearance, TB results, valid first-aid/CPR certification, and relevant training's. No deficiencies were issued during the time of visit. An exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 9:00 AM, LPA met with Licensee/Administrator Saif Choudry. An initial application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 11/22/2024 for a total capacity of six (6) with five (5) non-ambulatory and one (1) bedridden residents. Fire clearance was granted on 1/23/2025 as stated Bedroom #1 is approved for bedridden client, Bedroom #2, #3, #4 is approved for non-ambulatory clients, garage is off limits. LPA Delgado observed the following: Structure: Facility was a one-story house with four (4) resident bedrooms, two and half (2.5) resident bathrooms, family room, kitchen, dining with a large office area setup . There was an attached three car garage in the front of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Each resident bedroom #1 will accommodate bedridden resident, #2, #3 and #4 will accommodate any non-ambulatory resident. Four (4) resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: Two and half (2.5) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. (Continued on Page 2) (Continued from Page 1) At 10:01 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 119 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked cabinet located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the house. Laundry detergents and cleaning supplies were observed in laundry room that will be locked inaccessible to residents. Living/Family room: There was a living/family room for all clients and TV with streaming access. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence and hygiene supplies will be stored in the laundry room. Yards/Outside: Patio table and seating were observed in the backyard; shade is needed. There was a gate on the West side of the property with a self-latching hook. There is a pond 7' x 8' with no water and fire pit. All outdoor pathways were free of obstructions. There are three (3) window screens that are missing. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in all resident bedrooms and the main hallway. Obudsman poster and Let-Us-No poster observed. (Continued on Page 3) (Continued from Page 2) General items: One (1) fire extinguisher were charged and located in the kitchen. Six (6) smoke alarms and one (1) carbon monoxide detectors were tested and were observed to be in working order. Client records will be stored in a locked closet in the hallway. First Aid kit with required components and locked cabinet for medication storage was observed in the kitchen. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water supply and the required 72-hour emergency food supply was observed. Component III was completed February 11, 2025 at Riverside RO with LPM Tricia Danielson. Pre-Licensing is incomplete and the following corrections to be resolved by 3/4/2025: obtain shade for outdoor patio obtain PPE supplies repair hole in dining area ceiling remove 3 black cameras from interior areas remove personal storage clothing replace light bulb in foyer replace 3 exterior window screens An exit interview was conducted, and a copy of this report was given.the state’s words, verbatim · CDSS document, Feb 25, 2025