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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200395
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:59:17 AM

Document Has Been Signed on 03/13/2025 11:59 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PECO CARE HOMEFACILITY NUMBER:
019200395
ADMINISTRATOR/
DIRECTOR:		JEAN B. RODRIGUEZFACILITY TYPE:
735
ADDRESS:34914 PECO STREETTELEPHONE:
(510) 589-9419
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 5DATE:
03/13/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Jean RodriguezTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
NARRATIVE
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On this day at around 11:40am, LPA Luisa Fontanilla arrived to conduct a case management visit to issue deficiency in connection with the annual inspection conducted on 3/5/2025.

During the inspection, LPA observed the side exit gate was locked with a sliding bolt. Licensee states the side gate is not an exit. LPA reviewed the facility sketch and it does not indicate exits. LPA spoke with Licensee and informed him that LPA will not issue deficiency during the visit. However, LPA will verify with the Union City Fire Department and will have to come back to issue citation once verified with the fire inspector.

On 3/7/2025, LPA was informed by the fire inspector that the side gate is an emergency exit.

Deficiency is cited per Title 22 California Code of Regulations (refer to Lic 809D).
Civil penalty of $500 is assessed for today's visit.

Exit interview was conducted with the Administrator and Appeal Rights was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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Document Has Been Signed on 03/13/2025 11:59 AM - It Cannot Be Edited


Created By: Luisa Fontanilla On 03/13/2025 at 10:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PECO CARE HOME
FACILITY NUMBER: 019200395

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2025
Section Cited
CCR
80020(a)

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80020(a) Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
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The Administrator has unlocked the side gate.
Civil penalty of $500 is issued for today's visit.
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This requirement is not met as evidenced by: Based on observation, the facility did not comply with the above section by locking the side gate which poses an immediate health and safety risk for clients.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2025


LIC809 (FAS) - (06/04)
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