275294182-1-19-2023-24-AS-BCHN-CNKQMT-20230130111800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294182
Report Date: 12/07/2022
Date Signed: 01/19/2023 09:50:46 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/25/2022 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20221025133053

FACILITY NAME:	DRAKE HOUSE		FACILITY NUMBER:	275294182
ADMINISTRATOR:	JULIE HUYNH		FACILITY TYPE:	740
ADDRESS:	399 DRAKE AVENUE		TELEPHONE:	(831) 643-9069
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	55	CENSUS: 51	DATE:	12/07/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Julie Huynh		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff mismanaged resident's medications.

INVESTIGATION FINDINGS:

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This is an amended version of original report created on 12/07/22 due to the error, it is recorded as confidencial report instead of public report.
On 12/7/22 Licensing Program Analyst (LPA) V Gorban conducted an unannounced complaint inspection at 1000 hours. LPA met with Administrator Julie Huynh. The purpose of this visit is to deliver the finding of the investigation completed by the Department.

During the investigation, LPA completed interviews, requested documentation and reviewed facility files. Resident (R1) had prescription medications in R1’s belongings and R1 ingested them as hospital lvisit report stated R1 polypharmacy. According to Administrator, R1’s medications are to be centrally stored and managed by designated facility staff as medications are to be strong narcotics: Ativan and Seroquel.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20221025133053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DRAKE HOUSE	FACILITY NUMBER: 275294182
	VISIT DATE: 12/07/2022

NARRATIVE

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Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time.

Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiency was observed and cited on LIC 9099-D. Failure to correct the deficiency may result in civil penalties.

An exit interview was conducted, and a copy of this report dated 12/7/2022 along with Appeal Rights (LIC 9058) was provided to Administrator Julie Huynh whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20221025133053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DRAKE HOUSE	FACILITY NUMBER: 275294182
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/07/2022 Section Cited CCR 87465(h)(2)	1 2 3 4 5 6 7	87465(h)(2) Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This reqirement was not met as evidenced by LPA.	1 2 3 4 5 6 7	Per Administrator, facility will implement staf training and proceedure to safety search: medicatations, contraband, anything that needs to be stored and locked, of residentds upon coming back from outings. Training will be documented and copy reporte to department by 1/05/2023
	8 9 10 11 12 13 14	Based on interviews and records review, facility staff failed to secure and centraly store strong medications prescribed to resident which posses immediate health and safety risc to the resident.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC9099 (FAS) - (06/04)

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