<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317003105
Report Date: 08/30/2024
Date Signed: 09/03/2024 10:22:24 AM

Document Has Been Signed on 09/03/2024 10:22 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SCHNEIDER FAMILY HOMEFACILITY NUMBER:
317003105
ADMINISTRATOR/
DIRECTOR:		LEE, NICOLEFACILITY TYPE:
735
ADDRESS:455 RIVERVIEW DRIVETELEPHONE:
(530) 745-9872
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 6CENSUS: 3DATE:
08/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Nicole Lee, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/30/24 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.

LPA reviewed 2 resident files and 2 staff files.

LPA reviewed the CARE Tool with Administrator.

LPA was not able to interview any residents as they were not home at the time of the visit.

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: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1