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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005410
Report Date: 06/14/2024
Date Signed: 08/27/2024 11:53:13 AM

Document Has Been Signed on 08/27/2024 11:53 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: 5DATE:
06/14/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Jessica DizonTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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An Informal Conference was conducted today on 06/14/2024, via Microsoft Teams, with the Sacramento South Regional Office. Present in today's meeting were Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Charlie Yang; Valley Mountain Regional Center staff member Katina Richison and facility Licensee/Administrator Jessica Dizon and her husband Earl Dizon.
The purpose of the meeting was to discuss citations in regards to Personnel Requirements and Administrator Qualifications and Duties
LPM Liza King discussed with the Licensee/Administrator about the following citations and the associated plans of correction moving forward.

During today’s meeting, the facility designated Administrator Jessica Dizon agreed to the following:

  1. Have a certified facility Administrator on duty at least 20 hours per week at each facility for Schumard Care Home and Schumard Care Home 2
  2. Quarterly visits will be made out to each facility
  3. TSP referral, if agreed upon, by the facility designated Administrator

The department requested that the following to be completed and submitted into CCL for review:
  • LIC 500 to reflect Administrator hours of at least 20 hours per week at each licensed facility-Schumard Care Home and Schumard Care Home 2 by COB 06/17/2024
  • Licensee will review and make a decision about services with Technical Support Services (TSP).

The Licensee was notified that an email version of this document will be submitted to her corresponding email on file. It was requested that she review this document and provide a signed version back to this LPA.

There were no deficiencies observed or cited during today's office meeting. Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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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