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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275390040
Report Date: 10/31/2022
Date Signed: 11/03/2022 09:40:33 AM


Document Has Been Signed on 11/03/2022 09:40 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:PEACOCK ACRES THPPFACILITY NUMBER:
275390040
ADMINISTRATOR:WENDY BARKERFACILITY TYPE:
726
ADDRESS:1093 SOUTH MAIN STREET STE 106TELEPHONE:
(831) 754-3635
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:35CENSUS: 11DATE:
10/31/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Shaniz Beza, Excutive DirectorTIME COMPLETED:
03:30 PM
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On 10/31/22 at 11:49 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required Post Licensing Inspection. LPA met with Shaniz Beza, Executive Director (ED), at the above facility to conduct the required annual inspection.

LPA Simien reviewed five client files.

At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Shaniz Beza, ED, at 3:30 PM and a copy of the report sent to the facility.
SUPERVISOR'S NAME: Helga WongTELEPHONE: (408) 324-2123
LICENSING EVALUATOR NAME: Paul SimienTELEPHONE: 408-324-2112
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2022
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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