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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202535
Report Date: 11/18/2024
Date Signed: 11/18/2024 04:25:39 PM

Document Has Been Signed on 11/18/2024 04:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:DREXEL HOMEFACILITY NUMBER:
435202535
ADMINISTRATOR/
DIRECTOR:
FLOREZA, MARIESONFACILITY TYPE:
735
ADDRESS:1078 DREXEL WAYTELEPHONE:
(408) 646-0025
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 6CENSUS: 5DATE:
11/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Administrator Marieson FlorezaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit in regards an incident report, which stated a resident had struck another resident. LPA's met with Administrator Marieson Floreza. LPA's explained the purpose of the visit.

On November 7, 2024, the Department received an incident report, regarding resident R1. The incident report stated on November 6, 2024, R1 and his/her conservator met with ADM. R1 had disclosed past incidents of inappropriate sexual behavior with an individual/person, referred to as P1. The incident report included a written account of these incidents dating back to when 2019, 2022 and 2023.

On November 18, 2024, LPA interviewed R1. R1 stated he/she has informed the facility that he/she does not want to interact or meet with P1. R1 stated they have a protocol on what to do if P1 comes to the home. R1 stated P1 has not come to the home. R1 stated he/she is doing better.

LPA interviewed ADM. ADM stated based on what R1 has told her, these alleged interactions occurred outside the home. ADM stated she, R1 and R1's conservator created a plan on how to proceed, with R1's wishes to be in mind. ADM stated she will also ensure the facility is following R1's request of not seeing P1 and following the agreed upon plan of action.

ADM stated she has a written plan of action on how the facility will ensure R1 was safe. ADM Provided LPA with a copy of the signed safety plan for R1.

LPA determined that the above incident does not require further investigation. No deficiencies cited during today's visit. This report was reviewed with Administrator Marieson Floreza and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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