Sycamore Care Homes

Type of visit: Required - 1 Year

On December 9, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by staff. LPA Kim met with Licensee (LI) Emelyn Asis and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, studio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 108.5 Degrees F and 109.4 degrees F. A comfortable temperature of 72 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. An internet accessible videoconferencing device and a working telephone (714-463-4736) both remain available. First Aid kit had all the necessary elements. Certificate of Liability Insurance is effective from August 11, 2024, to August 11, 2025. Emergency Drills were conducted quarterly and was last conducted on November 21, 2025. Emergency food was stored in the closet across from Resident Room #1 and emergency water and emergency supplies were stored in the garage. The facility has two (2) fire extinguishers with an inspection date November 2, 2025 that were charged and mounted in the kitchen and next to the garage door. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S4), and medication and medication administration record that were in all order and complete. LPA Kim conducted interviews with two staff and one resident. No deficiencies were cited during the inspection visit. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Emelyn Asis.the state’s words, verbatim · CDSS document, Dec 9, 2025

Type of visit: Required - 1 Year

On December 3, 2024, at 8:00am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by staff. LPA Kim met with Licensee (LI) Emelyn Asis and explained the purpose of the visit. The facility is licensed to operate for five (6) nonambulatory residents and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, studio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with LI Asis. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 119.1 degrees F to 119.8 degrees F. A comfortable temperature of 71 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food was stored in the closet across from Resident Room #1 and emergency water and emergency supplies were stored in the garage. The facility has two (2) fire extinguisher that were charged, and mounted in the kitchen and next to the garage door. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-463-4736) remains available. First Aid kit had all the necessary elements. Certificate of Liability Insurance is effective from December 9, 2023, to December 9, 2024. LPA Kim conducted an audit of resident files (R1-R3), staff files (S1-S8), and medication and medication administration review that were in order and complete. LPA Kim conducted two (2) staff interview. A deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Emelyn Asis.the state’s words, verbatim · CDSS document, Dec 3, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility and was greeted and granted entry by Owner Emelyn Asis and designated Administrator (AD) Rose Ann Ang. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 6/26/2023. Structure: The facility is a one-story home with four resident bedrooms, two bathrooms, living room, kitchen, dining room, backyard, staff lounge and two car garage. There are two shaded seating areas in the backyard. There are two exit gates in the back yard. LPA observed no obstacles in back yard. LPA observed the ramp leading to the front door to make cracking sounds in some places. The ramp is still operable. Owner stated they will look into reinforcing or replacing the ramp. Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored under the kitchen sink. Medications, First-Aid Kit & Files: Medication will be stored in a locked cabinet in the kitchen. The First Aid Kit had all the required elements and is stored with medication and facility records. Fire Extinguisher: LPA observed the fire extinguisher to be fully charged and were purchased on 11/30/2023. Component III: Information provided about how to operate the facility within compliance and reporting requirements. Activity Materials: The facility has exercise equipment, books, puzzles, card/board games and art supplies. Fire clearance: Was approved by a fire inspector of Orange County Fire Authority on 7/20/2023. Bathrooms: The bathrooms have working plumbing. Hot water measured at 109.4 degrees Fahrenheit in the common bathroom and 110 degrees Fahrenheit in the bathroom in one of the shared rooms. Linens and Hygiene Supplies: A supply of extra linen and hygiene supplies is stored in the hallway closet Emergency Phone Numbers, Exit Plan and Menu: Posted and available for review. Food Service: There is 2-day supply of perishable food and a 7-day supply of non-perishable food on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors were tested and observed to be operational. Appliances: Gas stove, oven, refrigerator, dish washer, microwave, washer, and dryer are operational. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Nov 30, 2023

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 Interview Method: Telephone interview On 10/13/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 13, 2023