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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005410
Report Date: 07/18/2024
Date Signed: 07/19/2024 12:13:55 PM

Document Has Been Signed on 07/19/2024 12:13 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 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:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Jessica DizonTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Unannounced case management visit conducted on 07/18/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jessica Dizon.
A brief interview was conducted with the facility designated Administrator at this time.
Current census was 6 residents, of which (2) of them, were out of this facility at this time.
The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the informal conference which took place on 06/14/2024.

The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits:
  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 Jessica Dizon

There were no deficiencies observed or cited during today's case management visit.



Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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