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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294182
Report Date: 04/06/2022
Date Signed: 04/27/2022 10:25:23 AM


Document Has Been Signed on 04/27/2022 10:25 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
CCLD Regional Office, 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: 50DATE:
04/06/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:JP Butler, Julie Huynh, Emilio RubalcavaTIME COMPLETED:
02:49 PM
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An informal meeting was conducted by teleconference today to discuss capacity; specifically related to shower/tub requirements, and the following were in attendance.

Melinda Hoffmann, Licensing Program Analyst (LPA)
JP Bulter, Vice President
Julie Huynh, Administrator
Emilio Rubalcava, Program Director

During a visit at the facility on 3/19,2022 , LPA Medina discovered that facility is licensed for a capacity of 55 residents and they have (5) showers/tubs. Title 22 regulations require that there be at least one tub or shower for each ten (10) persons. In order to correct this oversight, it was agreed that facility will submit a change of capacity to include the following forms and a $25 fee: LIC 200, LIC 500, LIC 610E, LIC 999, LIC 9054.

If there are any changes to the above plan, the details will be memorialized in a subsequent report.

A copy of this report was emailed to Administrator for signature.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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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