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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005935
Report Date: 05/24/2023
Date Signed: 06/02/2023 02:45:18 PM

Document Has Been Signed on 06/02/2023 02:45 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
ORANGE & INLAND A/SC, 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: 5DATE:
05/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Mathew CarverTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit for the purpose of conducting an annual required visit. LPA arrived at facility was greeted and granted entry by staff. LPA met with Matthew Carver, Administrator and explained the nature of the visit.

LPA accompanied by Administrator began the tour of the inside of the facility. Facility is a three-story commercial building with a basement. Basement 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. LPA observe that the facility fire clearance is maintained in conformity with the State Fire Marshall regulatory standards. Smoke detectors and sprinkler systems are serviced annually by an outside vendor. Facility conducts fire drills quarterly. There are no pools, bodies of water at this location. Disinfectants cleaning solutions and poisons are inaccessible to clients and stored locked. The facility is maintained in a clean, safe, and sanitary condition. The premises and furnishings are in good repair. There are no food preparation areas at this site. Clients provide their own lunches and/or go out for lunch. Facility provides snacks as needed. Clients were in a class session at the time of visit and are adequately supervised to meet their needs. Facility does not handle medication for clients and therefore does not have a location for medication storage LPA observed all client’s have a medication lists on files. First aid supplies are adequate, and LPA observed a first aid kit mounted in kitchenette. LPA observed that there are First Aid kits throughout the facility . During the inspection LPA reviewed two staff records, three client records. All employees have a criminal record clearance. During the inspection LPA spoke to available clients and staff.



Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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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