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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803662
Report Date: 04/11/2023
Date Signed: 04/11/2023 02:38:23 PM

Document Has Been Signed on 04/11/2023 02:38 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 26DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Kaitlin Paulino, Program ManagerTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at The Peach Hub for the purpose of conducting an inspection regarding several self-reported incidents. LPA met with Program Manager Kaitlin Paulino, and was granted access into the facility. There were 26 clients and 18 staff on this date.

LPA toured the facility and found the facility to be clean and at a comfortable temperature with all exits free from obstruction. LPA interviewed staff member S1. Other staff members very involved with the clients providing support. There were a variety of activities going on: drawing, Karaoke, exercise, an outing to the park, therapy dog.

LPA observed clients were very socially engaged. Staff were adept at keeping clients safe and LPA did not witness any harmful behaviors. The facility has adequate space for clients to enjoy ample personal space, when necessary or requested. Incidents that have occurred have been discussed with responsible parties, Regional Center and their support staff (including behaviorist).

The Administrator/Licensee was on site at the time of visit and shared that they are always looking at what is best for all the residents and will continue to work with the clients and their supports to enable safe participation in the Peach Hub program.

There were no deficiencies found at the time of visit. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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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