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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004519
Report Date: 09/07/2022
Date Signed: 09/07/2022 04:07:01 PM

Document Has Been Signed on 09/07/2022 04:07 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:PEER HOME #1FACILITY NUMBER:
347004519
ADMINISTRATOR:CUPINO, RAULFACILITY TYPE:
735
ADDRESS:9560 CASTLECAVE WAYTELEPHONE:
(916) 585-9103
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 4CENSUS: 4DATE:
09/07/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Monica ButayTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a health and safety check on the residents residing in the facility on 9/7/22 at 3:15p. LPA met with Juvy Mac Donald, Caregiver and stated the purpose of the visit. Administrator Monica Butay arrived to assist with the visit.

Community Care Licensing received information that the air conditioning unit is not functional and will not be working until Saturday 9/10/22 and the residents are being relocated. At the time Regional Center visited today the temperature inside the facility was noted to be 85*F. The weather is stated to be a high of 108*F in Sacramento today. The Licensee is currently at the relocation site securing placement for the residents during this visit. The SIR has not been submitted yet as they were trying to rectify the problem and secure placement. It will be faxed after the residents are safely placed today.
During LPA visit the temperature is noted to be 84*F on the facility thermostat. LPA measured the temperature to be 85*F. The temperature inside the facility was observed to be at 85*F which is within the required range of 68-85*F. The residents are being relocated to Extended Stay America Suites Sacramento Elk Grove for comfort at this time. LPA observed a fan in each room, two in the common areas and 2 window air blowers. The Administrator was made aware of the broken air conditioner at 1am and the technician arrived at 9am. Administrator is relocating residents and requested Caregiver to sign todays report.

Per Title 22 Regulations 8088 Furniture, Fixtures, Equipment, and Supplies
(a) A comfortable temperature for clients shall be maintained at all areas. (1) The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Exit interview held, copy of report given
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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