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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294182
Report Date: 03/19/2022
Date Signed: 03/19/2022 01:32:49 PM

Document Has Been Signed on 03/19/2022 01:32 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:DRAKE HOUSEFACILITY NUMBER:
275294182
ADMINISTRATOR:JULIE HUYNHFACILITY TYPE:
740
ADDRESS:399 DRAKE AVENUETELEPHONE:
(831) 643-9069
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY: 55CENSUS: 50DATE:
03/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Julie HuynhTIME COMPLETED:
01:10 PM
NARRATIVE
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On 3/19/22, Licensing Program Analysts (LPA) M. Medina and L. Salazar arrived at the facility to conduct a complaint visit and observed the following during facility tour:

Facility has one operating shower for current census of 50 residents. Per staff conducting facility tour, showers on second floor are currently under repair.

The above deficiencies are being cited on the attached 809D.

An exit interview was conducted with Julie Huynh , signed on site and a copy of this report, Proof of Correction (LIC 9098) and Appeal rights will be provided via e-mail.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2022
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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Document Has Been Signed on 03/19/2022 01:32 PM - It Cannot Be Edited


Created By: Melinda Medina On 03/19/2022 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DRAKE HOUSE
FACILITY NUMBER: 275294182

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2022
Section Cited
CCR
87307(b)(2)

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PERSONAL ACCOMMODATIONS AND SERVICES: (b)Toilets and bathrooms shall be conveniently located. The licensed capacity shall be established based on Section 87158, Capacity, and the
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Facility restroom is being renovated and project is expected to be completed by Friday 3/25/22. Administrator to submit POC to Fresno CCL office by due date
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following: (2) At least one bathtub or shower for each ten (10) persons, which includes residents, family and live-in personnel.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Melinda Medina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2022


LIC809 (FAS) - (06/04)
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