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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317003105
Report Date: 09/11/2023
Date Signed: 09/11/2023 05:17:23 PM

Document Has Been Signed on 09/11/2023 05:17 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SCHNEIDER FAMILY HOMEFACILITY NUMBER:
317003105
ADMINISTRATOR:LEE, NICOLEFACILITY TYPE:
735
ADDRESS:455 RIVERVIEW DRIVETELEPHONE:
(530) 745-9872
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 6CENSUS: 3DATE:
09/11/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
04:32 PM
MET WITH:Nicole Lee, AdministratorTIME COMPLETED:
04:33 PM
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On 9/11/2023 LPA Tryon visited the facility to continue the annual. LPA met with Administrator Nicole Lee.
LPA toured the facility. Food supplies are adequate to meet the requirement of 2 days perishable and 7 days non-perishable. Bedrooms are appropriately furnished.
Medications are centrally stored and locked.
Smoke detectors installed and functioning, carbon monoxide detector installed.
Fire extinguisher present and charged.
There are currently 3 residents living at the facility.

Administrator certificate is current.

LPA attempted to open a CARE Tool, but was unable to do so.

AT this time the facility appears to be in substantial compliance with the regulations.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2023
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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