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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037003700
Report Date: 08/29/2023
Date Signed: 08/29/2023 11:46:57 AM

Document Has Been Signed on 08/29/2023 11:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SCHWABE RESIDENTIAL HOMEFACILITY NUMBER:
037003700
ADMINISTRATOR:SCHWABE, WILLIAM & CAROLFACILITY TYPE:
735
ADDRESS:18483 DAVIS ST.TELEPHONE:
(209) 245-4003
CITY:PLYMOUTHSTATE: CAZIP CODE:
95669
CAPACITY: 8CENSUS: 6DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Carol SchwabeTIME COMPLETED:
12:00 PM
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On 08/15/23, Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual inspection. LPA knocked on the door twice, emailed Administrator, and called the Administrator. Administrator informed LPA that they were out for the day. LPA to return at a later date.

On 08/29/23, LPA Valerio arrived unannounced to conduct an annual inspection. LPA met with Administrator Carol Schwabe, and explained the purpose of the visit. LPA and Administrator toured the facility to ensure compliance with Title 22 regulations. LPA observed the 4 bedrooms, 2 bathrooms, office area, living room, kitchen, dinning room, and exterior area. Bedrooms were fully furnished, clean, and free from debris. Bathrooms were clean and fully stocked. Hot water was measured at 106.3*F. Common areas were free from odor, clean, and free from debris. LPA observed medications, toxins, cleaning supplies, and sharps locked away and inaccessible to residents in care. The facility was observed to have a food supply to meet the requirements of 7 days of non-perishables and 2 days of perishable food items. The facility was also observed to have an emergency supply of food, water, and supplies. LPA observed 3 fire extinguishers and a pull alarm system to be fully functional and up to date with annual inspections.

Residents were out of the facility during the time of the visit. LPA spoke to staff during the visit. LPA reviewed staff and resident files. All files were up to date with current information. No health or safety concerns observed.

LPA requested the following documentation be sent to LPA by 09/05/23: LIC 500, LIC 308, LIC 610, and Surety Bond

Per California Code of Regulation (CCR) - Title 22, no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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