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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201470
Report Date: 02/13/2025
Date Signed: 02/13/2025 12:06:36 PM

Document Has Been Signed on 02/13/2025 12:06 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER:
079201470
ADMINISTRATOR/
DIRECTOR:		HALIBURTON, TIMOTHYFACILITY TYPE:
735
ADDRESS:433 FREMONT PEAK DRTELEPHONE:
(909) 287-3557
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 4CENSUS: 3DATE:
02/13/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:LICENSEE SHARON HAUN/ ADMINISTRATOR TIMOTHY HALIBURTON TIME VISIT/
INSPECTION COMPLETED:
12:16 PM
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On 02/13/2025 at 9:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived announced to conduct a pre licensing visit. LPA met with Licensee Sharon Han/Administrator Timothy Haliburton and explained the purpose of the visit. The facility is currently a group home with three (3) clients changing to an adult residential facility (ARF). Administrator currently holds a certificate #6068565735 expires: 05/22/2026. LPA observed no clients during visit. The facility’s fire clearance was approved for two (2) non-ambulatory and two (2) ambulatory clients.


LPA toured facility with Licensee/Administrator, including but not limited to four (4) bedrooms, two (2) bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Linens and hygiene supplies were observed inside a cabinet and in clients’ rooms. There is sufficient lighting throughout facility.

Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 107.0 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Emergency Disaster Plan last updated on 08/12/2024. Fire extinguisher was last serviced on 02/16/2024.


Continue on LIC809C
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PEOPLE'S CARE FREMONT PEAK
FACILITY NUMBER: 079201470
VISIT DATE: 02/13/2025
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Continued from LIC809


LPA reminded Licensee/Administrator to update all paperwork/documents to adult residential and remove child residential paperwork once licensed.


No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.


Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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