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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803662
Report Date: 01/21/2025
Date Signed: 01/21/2025 11:35:14 AM

Document Has Been Signed on 01/21/2025 11:35 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PEACH HUB, THEFACILITY NUMBER:
486803662
ADMINISTRATOR/
DIRECTOR:
GARCIA, JIM BERNARD PFACILITY TYPE:
775
ADDRESS:380 PITTMAN ROADTELEPHONE:
(707) 389-2403
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY: 45CENSUS: 40DATE:
01/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:03 AM
MET WITH:Joshua Reyes, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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At 9:05am Licensing Program Analyst (LPA), Robert Frank and Licensing Program Manager (LPM) Victoria Bertozzi arrived unannounced at Peach Hub, for the purpose of conducting a Required 1 year inspection. LPA and LPM met with Program Director (PD), Josh Reyes, and was granted access into the facility. Administrator Jim Garcia came to the facility during the Inspection.

At 9:30, LPA and LPM toured the 1 story facility with PD Reyes. Facility was found to be clean in good repair and at a comfortable temperature. The facility consists of a kitchen, 2 bathrooms, a computer room, library, an activity room, outdoor patio, and a staff office. Bathrooms contained grab bars, hygiene products and continence care products available for client use inside the closet and accessible. Hot water measured between 105 F -120 F degrees which is within Title 22 regulations. Participants typically bring their own lunches and snacks unless there is a party or special occasion. All exits were found to be unobstructed. Medication is stored in a locked cabinet in the staff office. Fire extinguishers were observed to be present with an inspection tag date of October 2024. The central fire system was serviced in October 2024. Carbon Monoxide and Smoke Detectors were tested and found to be operational during the inspection. First Aid kit was inspected and found have all required items. There was a covered deck and a large backyard behind the Facility. There was also a garden where clients are taught how to grow vegetables. Facility has sufficient PPE supplies. Clients were observed playing games with each other and doing a variety of activities with the staff. Five (5) client files and five (5) staff files were reviewed and all required documents were present. Staff was current with required ongoing training. LPA & LPM discussed status of the LLC with Administrator.

Continued on 809-C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PEACH HUB, THE
FACILITY NUMBER: 486803662
VISIT DATE: 01/21/2025
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...Continued from 809

LPA requested the following documents to be sent:

LIC 308- Designation of Responsibility
LIC 610D Updated Emergency Disaster Plan
Control of Property-Updated Lease


No deficiencies cited during today's visit. Exit interview conducted. Copy of report left with PD. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC809 (FAS) - (06/04)
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