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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 08:29:42 AM

Document Has Been Signed on 09/27/2022 08:29 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:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Julie HuynhTIME COMPLETED:
02:28 PM
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On 9/26/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management to follow up on in incident reported which occurred on and another reported to Department on 6/15/22 involving R2.

LPA reviewed and obtained copies of R1’s Needs and Appraisal, physician report, training records, and vehicle records during case management visit.

No deficiencies cited.
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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