<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275294182
Report Date: 10/21/2021
Date Signed: 10/21/2021 04:04:19 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
12/17/2020 and conducted by Evaluator Marybeth Donovan
COMPLAINT CONTROL NUMBER: 26-AS-20201217160944
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:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is unsanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the complaint finding for the above allegation. LPA met with Jenny Lombarte Assistant Adminsitrator.

The Department received notice of the above complaint allegations on 12/17/2020.

On 12/24/2020 Licensing Program Analyst (LPA) Marybeth Donovan conducted a Tele-Visit via FaceTme to open the 10 Day Complaint investigation. LPA toured the facility.

On 6/24/2021 LPA conducted an on site complaint visit and toured the facility. LPA interviewed 2 staff and 10 residents. LPA reviewed facility records to include Cleaning Schedulse and COVID Mitigation Prevention Plan.

Page 1 of 2
Unfounded
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-20201217160944
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Between 12/24/22020 and 6/24/2021 4 staff (S1-S4) and 10 residents (R1-R10) were interviewed. 4 of 4 staff interviewed stated that residents’ rooms are cleaned and disinfected daily to include changing linens and rooms are deep cleaned once a week and as needed. S2 stated that common areas are cleaned and disinfected every shift and as needed. Soiled furniture that is not cleanable is immediately removed and disposed of.

10 of 10 residents interviewed stated the facility is clean and sanitary.

Cleaning scheduled records confirmed completion of weekly deep cleaning of residents’ rooms for the periods of 11/30/2020 through 1/1/2021.

During facility tours on 12/24/2020, 3/4/2021, 6/24/2021 and 10/21/2021, LPA observed the facility to be clean and sanitary. LPA did not observe any soiled furniture nor did LPA observe any towels or magazines on furniture to cover stains or dampness of furniture.

The Department has investigated the complaint allegation listed. Based on interviews, observations and review of records, the Department has found that the complaint allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

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


Page 2 of 2
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