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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037003700
Report Date: 08/26/2024
Date Signed: 08/26/2024 04:18:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/26/2024 04:18 PM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SCHWABE RESIDENTIAL HOMEFACILITY NUMBER:
037003700
ADMINISTRATOR/
DIRECTOR:
SCHWABE, WILLIAM & CAROLFACILITY TYPE:
735
ADDRESS:18483 DAVIS ST.TELEPHONE:
(209) 245-4003
CITY:PLYMOUTHSTATE: CAZIP CODE:
95669
CAPACITY: 8CENSUS: 3DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Carol SchwabeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 8/2624, at 3:00 PM, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual inspection of the facility. Upon arrival, LPA Villanueva was greeted by Carol Schwabe, the Administrator, who was briefed on the purpose of the inspection. At the time of the visit, the facility had three residents present and two staff members on duty.

The inspection involved a tour of the facility to verify compliance with Title 22 regulations. LPA assessed various areas including the four bedrooms, two bathrooms, office, living room, kitchen, dining room, and exterior areas. The following observations were made: Bedrooms: Fully furnished, clean, and unobstructed. Bathrooms: Clean, well-stocked, with hot water measured at 106°F. Common Areas: Clean, odor-free, and unobstructed. Safety Measures: Medications, toxins, cleaning supplies, and sharp objects were securely locked and inaccessible to residents. Food supplies were properly stored, with a sufficient stock of 7 days' worth of non-perishables and 2 days' worth of perishable items. Three fire extinguishers and a pull alarm system were inspected and found to be fully functional and up-to-date.

Although the residents were initially away from the facility, they returned later during the inspection. LPA Villanueva also reviewed staff and resident files, confirming that all records were current. The facility conducts monthly disaster drills with residents to ensure preparedness.

During the visit, the Administrator informed LPA Villanueva of an upcoming change in service focus; the facility will be transitioning to provide respite services exclusively for adult residents, with most current residents scheduled to move out. No health or safety issues were identified.

LPA Villanueva requested the following documentation be submitted by end of day on 8/27/24: LIC 500, LIC 308, LIC 610, the current Liability Insurance Certificate, and the Surety Bond.

In accordance with the California Code of Regulations (CCR) - Title 22, no deficiencies were noted during this inspection.

An exit interview was conducted, and a copy of the inspection report was provided to the Administrator.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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