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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202407
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:07:48 PM

Substantiated


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
05/10/2021 and conducted by Evaluator Christine Dolores
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20210510124138
FACILITY NAME:MONTEREY BAY GUEST HOMEFACILITY NUMBER:
275202407
ADMINISTRATOR:EMMANUEL & JENNIFER INNEHFACILITY TYPE:
735
ADDRESS:1100 CARSON STREETTELEPHONE:
(831) 920-1796
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY:22CENSUS: 19DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Emmanuel InnehTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff do not treat residents with dignity
Facility has bed bugs
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the findings of the above allegations. LPA met with Administrator, Emmanuel Inneh.

On 05/19/2021, the Department opened the initial complaint investigation. The following documents were obtained to include staff roster, resident roster, admission agreement, house rules, client/resident personal property and valuables forms, and all eviction notices issued since January 2021.

From 05/19/2021 – 06/10/2021, a total of 6 residents (R1 – R6) were interviewed. Three out of six residents stated staff do not treat residents with dignity. Three out of six residents stated that the licensee has threatened the residents. Two out of six residents stated the Licensee has threatened to throw a resident out of the facility and has shoved a resident. One out of six residents stated staff has yelled and raised their voice at the resident a few times. Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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 5
Control Number 26-AS-20210510124138
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: MONTEREY BAY GUEST HOME
FACILITY NUMBER: 275202407
VISIT DATE: 05/20/2022
NARRATIVE
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Four out of six residents stated the facility has bed bugs. Three out of six residents stated the facility staff has sprayed all the facility residents’ mattresses to get rid of the bed bugs.

On 05/20/2022, a total of 4 staff (S1 – S4) were interviewed. Four out of four staff states staff treat the residents with dignity. Four out of four staff stated to not observe an incident where staff yelled, shoved, or threatened a resident.

Four out of four staff stated the facility had bed bugs last year. Four out of four staff stated facility does not have bed bugs anymore. Licensee states facility has a semi-annual exterminator that sprays the facility for insects that is on- going.

The Department has conducted an investigation of the above allegations. Based on interviews, the preponderance of evidence standard has been met. Therefore, the Department found the above allegations to be SUBSTANTIATED. A deficiency is being cited. See LIC 9099-D.

Exit interview conducted with Administrator, Emmanuel Inneh. A copy of this report, along with the facility's appeals rights were provided.

Page 2 of 2.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20210510124138
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: MONTEREY BAY GUEST HOME
FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2022
Section Cited
CCR
80087(a)(1)
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80087(a)(1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidence by:
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Licensee has corrected this deficiency by hiring a semi-annual exterminator. Licensee will ensure to keep facility free from bed bugs. Licensee will review section 80087 and send LPA a statement of understanding of the section and will send bed bug exterminator receipts via email by POC due date.
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Based on interview and record review, the licensee did not ensure to keep the facility free of bed bugs which poses an immediate health, safety, and personal rights risk to persons in care.
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Type B
05/27/2022
Section Cited
CCR
80072(a)(1)
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80072(a)(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidence by:
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Licensee will ensure to treat all residents with dignity. Licensee will review section 80072 and send LPA a statement of understanding of the section via email by POC due date.
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Based on interview, the licensee did not ensure to treat residents with dignity which poses a potential health, safety, and personal rights 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.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/10/2021 and conducted by Evaluator Christine Dolores
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20210510124138

FACILITY NAME:MONTEREY BAY GUEST HOMEFACILITY NUMBER:
275202407
ADMINISTRATOR:EMMANUEL & JENNIFER INNEHFACILITY TYPE:
735
ADDRESS:1100 CARSON STREETTELEPHONE:
(831) 920-1796
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY:22CENSUS: 19DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Emmanuel InnehTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful eviction
Staff did not safeguard residents personal belongings
Staff do not check on residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the findings of the above allegations. LPA met with Administrator, Emmanuel Inneh.

On 05/19/2021, the Department opened the initial complaint investigation. The following documents were obtained to include staff roster, resident roster, admission agreement, house rules, client/resident personal property and valuables forms, and all eviction notices issued since January 2021.

Based on record review, former resident’s 30-day eviction notice was effective exactly 30 days prior to final eviction date. The eviction notice stated reasons for eviction which included violating facility’s house rules listed on the admission agreement. The former resident’s client/resident personal property and valuables form was reviewed. Former resident’s client/resident’s personal property and valuables form did not include other items besides clothing. Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20210510124138
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: MONTEREY BAY GUEST HOME
FACILITY NUMBER: 275202407
VISIT DATE: 05/20/2022
NARRATIVE
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From 05/19/2021 – 06/10/2021, a total of 6 residents (R1 – R6) were interviewed. Two out of six residents stated staff check in on the residents two to three times a day. One out of six residents stated staff check in on the residents during breakfast, lunch, and dinner. One out of six residents stated staff check in on the residents more often when they are sick.

The Department has investigated the above allegations. Based on interviews conducted and records reviewed, the Department has determined that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

This report was reviewed with Administrator Emmanuel Inneh and a copy of this report was provided.

Page 2 of 2.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5