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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294182
Report Date: 09/26/2022
Date Signed: 09/27/2022 08:30:41 AM

Document Has Been Signed on 09/27/2022 08:30 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
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: 48DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julie HuynhTIME COMPLETED:
01:00 PM
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On 9/26/22, Licensing Program Analysts (LPA) M. Medina unannounced Annual Required Infection Control Inspection. LPA observed a central entry point with a supply of hand sanitizer located upon entry. A sign in policy that includes documented routine symptom screening for visitors is currently being implemented to follow current visitation guidelines. LPA introduced self and stated purpose of visit , LPA met with Julie Huynh, Administrator Certificate #6036684740, expires 6/14/23.

Facility toured with Jim Fletcher, Housekeeping/Maintenance Supervisor. Most bedrooms are double occupancy, with a minimum of 6-feet between beds. All resident bedrooms observed to have pull cords, when tested LPA observed staff response time to be under 2 minutes. Residents present during today's inspection observed to be sitting in dining/activity areas watching a televised music performance and others resting in their bedroom. Kitchen toured, LPA observed facility to have a 2-day of perishable and a 7-day supply of non-perishable food available. Medications are locked and secured in medication room, residents observed to have a 30-day supply of medication available. PPE is locked and secured and available if necessary.

Facility is equipped with a pull station and sprinkler alarm system. Carbon Monoxide detectors observed to be operational during today's inspection. Fire extinguishers present with a service date of 03/08/22.

LPA received copies of Administrator Certificate, CPR/First Aid Card, and LIC 610 Emergency Disaster Plan during inspection.

No deficiencies observed.

Exit interview conducted. Report signed on site and a copy provided to Administrator for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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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