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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202199
Report Date: 05/31/2023
Date Signed: 05/31/2023 02:32:23 PM

Document Has Been Signed on 05/31/2023 02:32 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SCHLOSSER HOMEFACILITY NUMBER:
435202199
ADMINISTRATOR:APRIL MAIMONFACILITY TYPE:
735
ADDRESS:3314 LYNN OAKS DR.TELEPHONE:
(408) 982-3103
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 6CENSUS: 0DATE:
05/31/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Christian PeytonTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - health checks visit. LPA met with Administrator (ADM), Christian Peyton.

During visit, LPA toured the facility with ADM to include the living room, resident bedroom, kitchen, and bathrooms. The facility observed clean with no dirt and pet hair throughout the floors of the facility. Staircase observed clean with no dust and dirt. LPA observed the residents bathroom on the second floor to be clean and sanitary with no water residue build-up all along the bathtub.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Christian Peyton and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2023
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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