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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270702591
Report Date: 05/12/2022
Date Signed: 05/12/2022 04:29:59 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/12/2022 04:29 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
CCLD Regional Office,
, CA
FACILITY NAME:GATEWAY CENTER OF MONTEREY COUNTY, INC.FACILITY NUMBER:
270702591
ADMINISTRATOR:CHRISTINA HUNTFACILITY TYPE:
775
ADDRESS:850 CONGRESS AVENUETELEPHONE:
(831) 372-8002
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY: 90CENSUS: 37DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Christina HuntTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual/random inspection on this date. LPA met with C. Hunt and explained the purpose of the visit.

LPA with Program Director inspected physical plant including but not limited to (5) class rooms, Large recreation room and Staff break room. LPA observed sufficient furniture and lighting throughout the facility. During the tour of the Day program LPA observed two stairs in the stairwell across from the laundry area as a potential trip risk and in need of repair (Citation given).

Hot water temperature was measured at 66.9 degrees Fahrenheit in the bathroom across from the senior classroom, which is not within the required range of 105 to 120 degrees (Citation Given). The smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present.

LPA observed centrally stored medications locked inside the manager's office. LPA with the assistance of facilities Director reviewed and compared resident medication vs. resident medication logs. First aid kit was checked and is complete. The last fire drill was conducted on 4/19/2022.

****Continued
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: GATEWAY CENTER OF MONTEREY COUNTY, INC.
FACILITY NUMBER: 270702591
VISIT DATE: 05/12/2022
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8 Staff and 12 Resident’s records were reviewed. The program was out of compliance with the 1 Staff to 3 Consumers ratio for today's census count. On-site today were 37 consumers and 10 staff (Citation given). Consumer files were reviewed and 8 of 12 Consumers had outdated IPPs (Advisory given).

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, Deficiencies were observed during this visit and cited on the attached 809D page.

Exit interview conducted and a report given at the conclusion of the inspection with appeal rights.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/12/2022 04:30 PM - It Cannot Be Edited


Created By: Albert Johnson On 05/12/2022 at 03:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
, CA

FACILITY NAME: GATEWAY CENTER OF MONTEREY COUNTY, INC.
FACILITY NUMBER: 270702591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2022
Section Cited
CCR
82088(e)(1)

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(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
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Licensee will develop a detailed plan outlining steps to correct and maintain water temperature within 105*F and 120*F. Plan to be submitted to LPA by POC due date. 5/26/2022
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Based on observation and verification through thermometer, hot water temperature in the bathroom was measured at 66.9*F which poses a potential health and safety risk to persons in care.
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Type B
05/26/2022
Section Cited
CCR82087(a)

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82087(a) Buildings and Grounds. The program site shall be clean, safe, sanitary, and in good repair at all times for the safety and well-being of clients, employees and visitors.
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The Licensee will repair or replace the two stairs in the stairwell and will send pictures of the repair to LPA Johnson by the POC date of 5/26/2022.
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This requirement is not met as evidenced by: Observation of two stairs in the stairwell across from the laundry area as a potential trip risk and in need of repair. This poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephenie Doub
LICENSING EVALUATOR NAME:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022


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Document Has Been Signed on 05/12/2022 04:30 PM - It Cannot Be Edited


Created By: Albert Johnson On 05/12/2022 at 03:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
, CA

FACILITY NAME: GATEWAY CENTER OF MONTEREY COUNTY, INC.
FACILITY NUMBER: 270702591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2022
Section Cited
CCR
82065.5(a)(1)

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(a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met:
(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center.
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The Program Director shall submit a staffing plan to CCL to ensure ratios are being met. An updated LIC500 shall be submitted to ensure that staffing needs are met
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This requirement is not met as evidenced by: Observation on-site today were 37 consumers and 10 staff. this does not meat the 1 to 3 ratio. This poses a potential health and safety risk to persons in care.
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for the consumers being served. POC shall be submitted by 5/26/2022.
Ratios shall be established at the start of the day, if the ratios are out of compliance then some Consumers will have to be sent home.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephenie Doub
LICENSING EVALUATOR NAME:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022


LIC809 (FAS) - (06/04)
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