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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005410
Report Date: 05/10/2024
Date Signed: 05/14/2024 04:20:45 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240313152928
FACILITY NAME:SCHUMARD CARE HOMEFACILITY NUMBER:
397005410
ADMINISTRATOR:DIZON, JESSICAFACILITY TYPE:
735
ADDRESS:18268 SCHUMARD OAK ROADTELEPHONE:
(209) 323-5590
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:6CENSUS: 6DATE:
05/10/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jazmine CastilloTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility Administrator is not at the facility for a sufficient amount of time
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 05/10/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility house manager, Jazmine Castillo, who was briefly interviewed at this time. This LPA also requested that she go ahead and notify the facility designated Administrator, Jessica Dizon, to let her know that CCL was present at this time.
Current census was 6 residents but all of them were out of the home at this time at their respectable day programs.
The purpose of this visit was to deliver the findings of this investigation to this facility and it's representative at this time.
Based on interviews conducted, it was learned that the facility designated Administrator, Jessica Dizon, was split between the two licensed care homes, Schumard Care Home #397005410 and Schumard Care Home 2 #392700130. It was learned that Schumard Care Home was located in the city of Lathrop while Schumard Care Home 2 was located in the city of Tracy.
It was learned that the facility designated Administrator, Jessica Dizon, was the only certified Administrator
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20240313152928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SCHUMARD CARE HOME
FACILITY NUMBER: 397005410
VISIT DATE: 05/10/2024
NARRATIVE
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for both of these care homes at this time.
Based on interviews it was learned that the facility designated Administrator was present at this care home about 2-3 times a week. It was learned that she would be present in the care home for 3-4 hours when she was present. Based on the days and times present at this facility it amounted to a total of 12 hours a week.
Based on a review of the records, it was learned that the days that Jessica Dizon was present at this care home varied from week to week. The dates and times when the facility designated Administrator was present would often times contradict the days and hours set forth on the LIC 500 that was submitted into CCL. This LIC 500 was completed and submitted by the facility designated Administrator and dated on 04/09/2024.
Based on a review of the records, it was learned that the days and hours set forth on the forms and documents that were submitted into CCL by the facility designated Administrator had an overlap of days and times where it would not have been possible for her to be present at both facilities since she was scheduled at both care homes.
As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility house manager at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240313152928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SCHUMARD CARE HOME
FACILITY NUMBER: 397005410
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/11/2024
Section Cited
CCR
85064(e)
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The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.
This is not met as evidenced by:
Based on review of the facility records and interviews, the facility designated
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The facility representative stated that an updated LIC 500 will be updated on a weekly basis to include proper dates and times when the facility designated Administrator will actually be present at this facility. A statement of correction, along with the updated LIC 500, will be completed and
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Administrator is not present for a sufficient number of hours to properly oversee and manage the day-to-day operations of this facility. This posed an immediate threat to the Health, Safety, and Personal Rights of residents in care.
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submitted into CCL by the due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3