275294182-10-21-2021-26-AS-KHOS-C9GK9R-20211207064246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294182
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:39:56 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
05/05/2021 and conducted by Evaluator Marybeth Donovan

COMPLAINT CONTROL NUMBER: 26-AS-20210505154404

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: 50	DATE:	10/21/2021
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Jenny Lombarte		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is not providing a comfortable outdoor space for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the complaint finding for the above allegation. LPA met with Jenny Lombarte Assistant Administrator.

The Department received notice of the above complaint allegations on 5/5/2021.

On 5/6/2021 Licensing Program Analyst (LPA) Marybeth Donovan conducted a Tele-Visit via FaceTime to open the 10 Day Complaint investigation.

On 5/6/2021, 6/24/2021 and 10/21/2021 conducted tour of the facility inside and out.

Between 5/6/2021 and 6/24/2021 LPA interviewed 4 staff and 10 residents.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth Donovan	TELEPHONE: (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)

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Control Number 26-AS-20210505154404

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 the facility provides comfortable outdoor space for residents. The back patio area is cleaned a minium of 2 times a day and as needed. 9 of 10 residents stated the staff clean the area regularly to keep it clean and comfortable. 1 of 10 , R9 does not like the smoke from the designated smoking area but would not use the area anyway. R5 stated that some residents do not discard their cigarette butts is the trash receptacle.

Based on information from interviews conducted, observations and records reviewed, although the allegations 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 allegation is 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 Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth Donovan	TELEPHONE: (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)

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