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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801322
Report Date: 02/09/2023
Date Signed: 02/10/2023 09:24:53 AM

Document Has Been Signed on 02/10/2023 09:24 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:D SCHWED ADULT FAMILY HOMEFACILITY NUMBER:
405801322
ADMINISTRATOR:DOLLY SCHWEDFACILITY TYPE:
735
ADDRESS:3950 BRANCH ROADTELEPHONE:
(805) 238-6331
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 6DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dolly Schwed/LicenseeTIME COMPLETED:
12:45 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
 At 9:45am on 02/09/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct that annual, infection control inspection. LPA was greeted at the door by Licensee Dolly Schwed. LPA announced who he was and the reason for the visit. LPA was screen per current infection control best practices upon entrance to the facility.
Licensee and conducted a cursory walk through of the facility. This is a five bedroom two bathroom facility, with two single client rooms and two double occupancy client rooms. All rooms met regulation requirements. There is a kitchen two living rooms and a laundry room and a sprawling gated property (aprox. 1 acre). LPA observed working fire detectors in every room, carbon monoxide detector in the hallway and working and currently tag fire extinguisher. LPA observed more than two days of perishable foods and more than seven days of non-perishable foods. LPA observed medication and chemicals locked in the laundry room and medication additionally locked in lock boxes in the laundry room. LPA noted that the water temperature in the facility was within regulation range of 105*-120*(f). LPA observed a complete fist aide kit in the laundry room. LPA noted that all exits were free and clear of obstructions. LPA noted that the facility is exceptionally clean and in good repair. LPA observed paper towels and liquid soap in the facility bathrooms. LPA observed 30 day supply of PPE on hand at this facility. LPA observed the shed on the back side property and viewed tool and supplies for ground maintenance. LPA noted that no violations, technical, or citations as a result of the cursory walk through tour.
Licensee and LPA conducted the infection control portion of the annual inspection. Licensee and LPA engaged in a one hour and thirty minute verbal review of the infection control care tool module on infection control. LPA reviewed at a later time all seventy four elements of the infection control module to confirm that there were no violations, technical, or citations issued as a result of the infection control module of the annual inspection
.
Exit Interview, report read, and report emailed due to technical issues at time of annual inspection visit.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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