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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202199
Report Date: 02/22/2024
Date Signed: 02/23/2024 07:58:53 AM

Document Has Been Signed on 02/23/2024 07:58 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
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: 6DATE:
02/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shirley Schlosser aka Shirley EmlerTIME COMPLETED:
05:00 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
LPA Partoza, conducted a plan of correction visit to ensure that the deficiencies cited on 1/30/2024 are corrected based on CCR Title 22 and to amend LIC 809D issued on 1/30/2024.
The LIC 809D issued did not have the plan of correction at the time of issuance and is being amended to reflect the plan of corrections (POC).

A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500), for the individual who was residing at the facility without criminal record clearance. Please see LIC 421BG for the deficiencies that was cited on 1/30/2024.

LPA cleared the following deficiencies cited on 1/30/2024:
  • LPA checked for individual clearances for individuals who resides in the facility who has no background clearance. LPA found that the individual cleared background and is currently associated with the facility.
  • LPA conducted a tour of the facility inside and out and observed that some of the deficiencies cited have been cleared. All toxic materials were kept in a locked cabinet and not easily accessible. Sharps are stored in a locked cabinet.

LPA discussed the following citation with the licensee. As of today's visit the deficiencies cannot be cleared until proof is submitted.
  • LIcensee is in the process of associating an administrator for the facility and will be part of the facility staff. LIcensee have shown a copy of the certificate of completion for Adult Residential Facilities (ARF).
  • Licensee is in the process of getting her administrator certificate and will have an administrator in place until a certificate is issued to her.
No deficiencies is cited as of today's visit.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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