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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801835
Report Date: 05/17/2023
Date Signed: 05/17/2023 11:15:00 AM

Document Has Been Signed on 05/17/2023 11:15 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:SCHWED ADULT FAMILY HOME IIIFACILITY NUMBER:
405801835
ADMINISTRATOR:DOLLY SCHWEDFACILITY TYPE:
735
ADDRESS:648 LAURA WAYTELEPHONE:
(805) 239-2570
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 4DATE:
05/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Administrator/Amy HicksTIME COMPLETED:
11:30 AM
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At 8:20am on 05/17/2023, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the annual inspection. LPA met with Administrator Amy Hicks and announced who he was and the reason for the visit.
Administrator and LPA contacted prior administrator Dolly Schwed by phone to ensure that facility will update current administrator within the next 10 day from the date of this report. Administrator and LPA conducted a physical tour of the facility. LPA noted that for following observations: Smoke detectors and carbon monoxide detectors were all functioning correctly throughout the facility. Both fire extinguishers were properly charged in the green range. No obstructions in walkways or entrance/exits were observed. LPA observed at least 2 days of perishable foods and at least 7 days of non-perishable foods. LPA observed all three client bedroom and two client bathrooms. All client bedrooms had appropriate linins, lighting and storage for clients. Both client restrooms had nonskid mats or floors in showers and all hand railing was stable. LPA observed emergency water in the garage and emergency disaster plan was posted in the kitchen. LPA noted that all posting were posted in hallway or kitchen common areas. LPA noted that the facility was clean and in good repair and did not observe any items notable of violation, citation or technical. LPA did note that the side fence was leaning and the adjacent neighbor to the south of the home that shares the fence was prepping to repair, LPA will follow up on date repair was finished.
Administrator and LPA conduction a review of each module of the annual inspection tool. LPA noted that there were no citations, violations, or technical noted during the annual inspection module review of the inspection tool. Final result of this annual inspection did not show and violations, citations or technical at this time.

Exit interview, report read, report signed and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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