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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801322
Report Date: 03/14/2024
Date Signed: 03/14/2024 09:56:44 AM

Document Has Been Signed on 03/14/2024 09:56 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: 5DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Licensee/Administrator Dolly Schwed TIME COMPLETED:
10:29 AM
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 At 8:15am on 03/14/2024, Licensing Program Analyst Jeffries arrived unannounced to the facility to conduct the annual inspection visit. LPA met with Licensee/Administrator Dolly Schwed announced who he was and the reason for the visit.

This facility is located in a rural area just outside of the City of Paso Robles. It sits on a 1 acre parcel and is fenced all the way around. The facility has well warter and the well water was tested on 07/26/2023 by Filipponi & Thompson Drilling, lab work by Abaline Coast Analytical, Inc. and met all compliance regulations. The facility consist of 6 total bedrooms and 2 bathrooms.There are 4 client bedrooms and 1 client bathroom that is shared. There is a complete first aide kit located the the Landry room where the medications are also stored and is locked. There are two living rooms and a large yard all around the facility with chairs and umbrellas for shade. Administrator and LPA conducted a complete walking tour of the facility. LPA noted that the medication, staff and client documentation are all up to date and meet regulation requirements. LPA observed working smoke alarms and a working carbon monoxide in the facility. LPA observed a fire extinguisher and all passage ways and hallways were free and clear of obstacles and debit. LPA noted that the facility is very clean and in good repair. LPA observed at least 2 days of perishable food and at least 7 days of non-perishable foods on hand at the facility. LPA noted that the facility water temperature is within the compliance range of 105*-120* (f).

Administrator and LPA conducted a full review of the annual care tools modules. LPA noted that a full review of the care tools modules revealed no technical,violations, or citations. LPA noted that the full annual inspection resulted in no technical, violations, or citations.


Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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