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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294182
Report Date: 09/05/2023
Date Signed: 09/06/2023 08:17:39 AM


Document Has Been Signed on 09/06/2023 08:17 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
SIERRA CASCADE AC/SC, 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: 51DATE:
09/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Julie Huynh - AdministratorTIME COMPLETED:
12:00 PM
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On 9/5/2023, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct a case management inspection. LPA met with Administrator Julie Huynh and announced the purpose of the visit.

This visit was conducted in order to follow up on an incident which occurred on 8/22/2023 and was reported to CCLD on 8/23/2023. During the visit, LPA interviewed Administrator and obtained records. On 8/22/2023, a facility resident, Resident 1(R1), was admitted to Community Hospital of the Monterey Peninsula. R1 was discharged back to the facility on 8/28/2023 and returned to the facility with a diagnosis of pneumonia.

No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted with the administrator.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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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