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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202199
Report Date: 01/22/2025
Date Signed: 01/22/2025 01:48:20 PM

Document Has Been Signed on 01/22/2025 01:48 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/
DIRECTOR:
APRIL MAIMONFACILITY TYPE:
735
ADDRESS:3314 LYNN OAKS DR.TELEPHONE:
(408) 352-5317
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 6CENSUS: 6DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:April MaimonTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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Licensing Program Analysts (LPA) Santino Fortes conducted an unannounced annual inspection, and met with Administrator April Maimon. ADM informed that facility has 1 staff and 6 clients. 1 resident was resting in their room and 5 at day program.

LPA toured the facility inside and out including: kitchen, living room, family room and 4 staff rooms, 5 resident rooms (1 shared), and 4.5 restrooms. Restrooms all observed to have non skid flooring. LPAs observed perishable food supply of at least two days and non-perishable food supply of at least seven days. Refrigerator temperature was observed at 40 degrees F and Freezer temperature was 0 Degrees F. The front yard and backyard of the facility was also inspected. There was no obstruction to block the outdoor exit. Two sheds were observed storing garden tools and household items. LPA observed Facility License and Resident Personal rights were posted.

LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. Room temperature was at 71 degree F, and hot water temperature was measured at: Kitchen-119*, Bath 1-115*, Bath 2-117*degrees F. LPA inspected the facility first aid kit and it was observed to be complete. The facility was equipped with smoke and carbon monoxide detectors and all functioned properly when tested. Fire extinguishers were last serviced on 2/12/24. The facility conducted their last fire drill on 12/30/24.

LPA reviewed facility records for 2 staff and 5 clients. LPA reviewed 5 clients medications, centrally stored medication records and P&I records.

No deficiencies were cited during today's visit as per California Code of Regulations Title 22. Exit interview was conducted with ADM. This report was reviewed and a copy was provided to ADM for signature.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Santino Fortes
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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