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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803662
Report Date: 11/09/2021
Date Signed: 11/09/2021 12:52:03 PM

Document Has Been Signed on 11/09/2021 12:52 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:PEACH HUB, THEFACILITY NUMBER:
486803662
ADMINISTRATOR:GARCIA, JIM BERNARD PFACILITY TYPE:
775
ADDRESS:380 PITTMAN ROADTELEPHONE:
(707) 389-2403
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY: 45CENSUS: 30DATE:
11/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jim Bernard, AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Lopez arrived to The Peach Hub facility unannounced regarding complaint investigation. Upon arrival LPA noticed that day program had cameras inside and outside facility. LPA asked Administrator, Jim Bernard if the cameras inside their facility had audio and he stated they did not. LPA observed cameras in facility but not in restrooms. LPA asked Administrator if they had the video surveillance in their program plan and they do not but their admission agreement does state that their facility does have video surveillance in main room. Administrator stated that he wants to update the admission agreement so that it states that there are cameras are in all facility since Administrator previously stated that there were cameras in main room but Administrator added more cameras in facility but not in restrooms. Cameras outside do currently have audio for security purposes. Administrator will update their program plan so that it states that the camera audio will be turned on outside only when facility is not operating.

LPA Lopez also noticed that facility had a new large deck that needed to be added to their facility sketch (photos taken). Administrator stated that they had their fire inspection recently and there were no violations. Facility currently has no clients attending in-person day program due to COVID-19. LPA requested a new facility sketch for their facility to be submitted to Community Care Licensing.

LPA requested facility to submit updated documents by 11/16/21 :
-Plan of Operation
-Facility Sketch

LPA received the following documents during unannounced visit:
-Updated Admission agreement (which will be given to all current clients and kept for facility records)
-Recent fire inspection

No deficiencies cited during todays inspection.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Karen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
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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