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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005935
Report Date: 06/02/2022
Date Signed: 06/02/2022 10:59:38 AM

Document Has Been Signed on 06/02/2022 10:59 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PEER MENTAL WELLNESSFACILITY NUMBER:
306005935
ADMINISTRATOR:CARVER, MATHEW WILLIAMFACILITY TYPE:
775
ADDRESS:305 W. 4TH ST.TELEPHONE:
(714) 357-9988
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY: 30CENSUS: DATE:
06/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Administrator, Mathew CarverTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA met with Administrator Mathew Carver and explained reason for visit.

LPA conducted tour with Administrator and observed the required Department postings. There is a sign-in procedure in place and hand sanitizer for use. LPA observed that staff were wearing face masks. Facility is a three story commercial building with a basement. Basement area is used for staff lounge only. LPA observed 3 clinical office rooms and plenty of Ample seating in each common area. Facility has 2 restrooms with working wash basin, soap, paper towels and toilet paper. Facility has 5 Fire extinguishers fully charged and mounted. LPA observed Paperwork from OC Fire Authority of passed inspection on 2/17/21 regarding Smoke detectors, sprinkling system and Carbon Monoxide detectors. The facility utilizes a cleaning service to maintain the campus. Facility is following infection control and COVID guidelines. Adult day program has 7 clients in care. LPA observed clients relaxing in common areas. LPA observed 7 out of 7 client files. All clients Emergency contact info and Physician's reports are current. Facility does not administer medications on site. LPA observed all clients medication lists in files. Facility has designated visitation area. Facility has emergency food and water.

Based on observations made during today’s inspection, no deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report with Program Administrator and copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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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