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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005410
Report Date: 02/10/2025
Date Signed: 02/11/2025 10:37:45 AM

Document Has Been Signed on 02/11/2025 10:37 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SCHUMARD CARE HOMEFACILITY NUMBER:
397005410
ADMINISTRATOR/
DIRECTOR:		DIZON, JESSICAFACILITY TYPE:
735
ADDRESS:18268 SCHUMARD OAK ROADTELEPHONE:
(209) 323-5590
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 6CENSUS: 6DATE:
02/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Debbie PeppyTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Unannounced Plan of Correction visit made out to this facility on 02/10/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person Debbie Peppy. A brief interview was conducted with the facility staff person at this time. This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Jessica Dizon, to inform her that CCL was present at this time.
Current census was 6 residents.
The purpose of this visit was to follow up on the deficiencies that were cited from a prior complaint visit conducted on 12/19/2024. This visit was to follow up on the Plans of Correction that were due.
The following deficiencies were observed and cited on 12/19/2024:
  • The licensee shall provide care and supervision as necessary to meet the client's needs. This facility was found to be deficient as evidenced by the lack of oversight, communication, and proper documentation of the resident's medications which should have been taken on a routine and PRN basis as prescribed by the licensed medical professional.

This facility did complete the Plans of Correction and provided all of the required forms and documents at this time.
Plan of Correction clearance letters were printed and copies were provided to the facility staff person at this time.
There were no further deficiencies observed or cited during today's Plan of Correction visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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