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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200234
Report Date: 11/28/2023
Date Signed: 11/28/2023 04:05:08 PM

Document Has Been Signed on 11/28/2023 04:05 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PEACE HOMEFACILITY NUMBER:
019200234
ADMINISTRATOR:CHRISTOPHER IBHAWOFACILITY TYPE:
735
ADDRESS:2076 STRANG AVENUETELEPHONE:
(510) 278-8350
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 3CENSUS: DATE:
11/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Grace Ibhawo, OwnerTIME COMPLETED:
04:15 PM
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On 11/28/23 at 2:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Grace Ibhawo, Owner and explained the purpose of the visit. The facility’s fire clearance was approved for 3 clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 3 total bedrooms which all 3 are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the kitchen was measured at 110-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 2/15/23. First aid kit was observed to be complete.

LPA reviewed 3 clients’ records and 3 staff records, and all were complete. A sample of 2 client’s medications were reviewed.

Updated copies of the following document are requested for facility file and are to be submitted to CCL by 12/12/23: LIC610E Emergency Disaster Plan.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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