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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005345
Report Date: 08/04/2023
Date Signed: 08/04/2023 03:14:34 PM

Document Has Been Signed on 08/04/2023 03:14 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:MONICA FLOR G BUTAYFACILITY TYPE:
735
ADDRESS:7727 MASTERS STREETTELEPHONE:
(916) 509-9450
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 4CENSUS: 4DATE:
08/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Monica ButayTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management inspection of Peer Home 2. LPA met with Administrator Monica to ensure the facility is in compliance with applicable statutes and regulations.

During the visit, the LPA conducted interviews with staff. Based on interviews, staff receive pay checks bi-weekly, never receive a late pay check, have waived breaks, and are currently not approved to work any overtime. There is not any live-in care staff at the home. LPA reviewed staff files and resident files. The facility was observed to have 3 direct staff on shift. There were 2 residents present and 2 residents away at Day Program.

The LPA conducted a tour of the physical plant and observed the facility to be within compliance with Title 22 regulations. Common areas were clean and free of debris. Resident rooms has necessary furniture and furnishings. The facility had a food supply enough for 7 days of perishables and 2 days of non-perishables. Sharps, medications, and toxins were locked and inaccessible to residents in care. Appropriate Federal Labor Law signs was observed on the wall near the front entrance.

Based on interviews, file review, and observation of the physical plant, it appears the facility is in compliance with applicable statues and regulations.An exit interview was held with Administrator, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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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