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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005345
Report Date: 02/23/2022
Date Signed: 02/23/2022 12:53:52 PM

Document Has Been Signed on 02/23/2022 12:53 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 2FACILITY NUMBER:
347005345
ADMINISTRATOR:ANTONIO "TANYA" BERNADASFACILITY TYPE:
735
ADDRESS:7727 MASTERS STREETTELEPHONE:
(916) 509-9450
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 4CENSUS: 4DATE:
02/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Geoffrey LopezTIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Christina Valerio and LPA Jamie Ivey-Canady conducted a case management inspection of Peer Home 2. LPAs met with Staff Lead Geoffrey Lopez to ensure the facility is in compliance with applicable statutes and regulations. LPAs confirmed with staff there are zero residents or staff that have displayed any signs or symptoms of COVID-19 in the last 10 days.

During the visit, the LPA conducted interviews with 3 staff. Based on interviews, staff are paid bi-weekly, never receive a late pay check, and have waived lunch breaks while on shift. There are no live-in care staff at Peer Home 2.

The LPA reviewed staff/resident files and resident medications and observed all necessary documents in the file. LPA reviewed facility guardian roster with facility LIC 500 and staff schedule. Staff 1 and Staff 2 were not observed on the guardian roster, however, had fingerprint clearance letters in their file. Technical assistance was provided to ensure the facility completed the fingerprint clearance transfer from Cupino Home to Peer Home 2. Cupino Home is another licensed care facility operated by the same licensee.

The LPA conducted a tour of the physical plant and observed 2 residents and 3 staff members present in the facility. Later during the visit, 2 additional residents returned from day program. LPAs observed proper signage regarding COVID-19, California Minimum Wage Notice, and Emergency Disaster Plan.

Based on interviews, file/medication reviews, and observation of the physical plant, it appears the facility is in compliance with applicable statutes and regulations. An exit interview was held with Lead Staff Geoffrey Lopez and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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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