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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275294182
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:42:40 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/26/2021 and conducted by Evaluator Marybeth Donovan
COMPLAINT CONTROL NUMBER: 26-AS-20210226162619
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:
10/21/2021
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jenny LombarteTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Facility not properly preparing food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the complaint findings for the above allegations. LPA met with Jenny Lombarte Assistant Administrator.

The Department received notice of the above complaint allegations on 2/26/2021.

On 3/4/2021 Licensing Program Analyst (LPA) Marybeth Donovan conducted a Tele-Visit via FaceTime to open the 10 Day Complaint investigation. LPA toured the facility.

Between 3/4/2021 and 6/24/2021 4 staff and 11 residents were interviewed. Records reviewed included resident Menu for 1/31/2021 through 3/6/2021, Resident Diet Orders, Refrigeration Temperature Logs for 2/2021.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 26-AS-20210226162619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: DRAKE HOUSE
FACILITY NUMBER: 275294182
VISIT DATE: 10/21/2021
NARRATIVE
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4 of 4 staff stated that food was properly prepared and no undercooked food served to residents. S2 stated that the food temperature is checked upon completion of the cooking process and then placed in the oven to keep warm. Prior to serving the food temperature is checked again before service. All staff were unaware of any issues with food service.

10 of 11 residents stated that they did not have any issues with food service nor where they served undercooked food. 1 of 11 residents stated that a hamburger served was pink in the middle. R5 told staff and the cook corrected the concern. There were no further issues. R5 could not provide further details of this event.

Temperature Logs were reviewed. Refrigerators and freezers temperatures were maintained within a Safe Temperature Zone. Refrigerators temperatures recorded at 40 degrees F or below and Freezers at 0 degrees F or below for the Month 2/2021.

Based on information from interviews conducted and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No Deficiencies cited under California Code of Regulations Title 22.

Exit interview conducted with Jenny Lombarte Assistant Administrator and a copy of this report provided.

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SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2