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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 12:06:27 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
09/17/2021 and conducted by Evaluator Christine Dolores
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20210917165229
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:
10:30 AM
MET WITH:Emmanuel InnehTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff abandoned resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the findings of the above allegations. LPA met with Administrator Emmanuel Inneh.

On 09/23/2021, the Department opened the initial complaint investigation. The following documents were obtained to include former resident’s physician’s report, admission agreement, patient face sheet, identification and emergency information, appraisal needs and services plan, and resident roster for July 2021.

On 09/16/2021, resident in question was brought to the Emergency Room by APS. Based on interview, the resident did not return to the facility after a hospital visit due to needing higher level of care. Resident did not have an appropriate placement prior to the refusal of licensee taking the resident back to the facility.
On 09/23/2021, a total of four staff (S1 – S4) were interviewed. Four out of four staff stated a resident was taken to the hospital and has not returned to the facility.
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 7
Control Number 26-AS-20210917165229
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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On 09/24/2021, a total of three witnesses (W1 – W3) were interviewed. Three out of three witnesses stated the resident was taken to the hospital and did not return to the facility. One out of three witnesses stated the resident was to return to the facility, but the crisis counselor and licensee cited the resident was not appropriate to return to the facility due to needing higher level of care. Licensee had stated he had tried all avenues to get resident to a higher level of care but never modified the care plan. He further stated that hospital and family member tried unsuccessfully to force him to accept the resident back.

Based on record review, the facility did not follow the proper protocol of taking the resident back upon discharge and then issuing an eviction notice if there is good cause prior to refusing to take the resident back after a hospital visit. The appraisal, needs and services plan dated 6/17/19 reviewed noted nothing on the need for higher level of care.

The Department has investigated of the above allegations. Based on interviews and record review, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation 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.
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 7
Control Number 26-AS-20210917165229
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
85068.5(a)(4)(A)
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(a)The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following reasons: (4) Inability to meet the client's needs. (A) A Needs and Services Plan modification must have been performed, as specified in Section 80068.3(a), which determined that the client's needs cannot be met by the facility and the client has been given the opportunity to relocate as specified in Section 80068.3(b). This requirement is not met as evidence by:
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Licensee will review section 85068.5 and ensure to modify client’s needs and services plan when a client has a change of condition and/or needs higher level of care, prior to evicting a resident, if determined the resident’s needs cannot be met at the facility. Licensee will email LPA POC by 05/21/2022.
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Based on interview and record review, the licensee did not ensure to perform a reassessment noting higher level of care prior to eviction which poses an immediate 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 7
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
09/17/2021 and conducted by Evaluator Christine Dolores
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20210917165229

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:
10:30 AM
MET WITH:Emmanuel InnehTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff did not meet resident’s hygiene needs
Staff did not provide basic laundry services for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the findings of the above allegations. LPA met with Administrator, Emmauel Inneh.

On 09/23/2021, the Department opened the initial complaint investigation. The following documents were obtained to include former resident’s physician’s report, admission agreement, patient face sheet, identification and emergency information, appraisal needs and services plan, and resident roster for July 2021.

On 09/23/2021, a total of five residents (R1 – R5) were interviewed. Five out of five residents stated the staff are meeting their hygiene needs. Two out of five residents stated a resident did not know how to use the bathroom and would do his business in the room but stated staff would clean after this resident. One out of five residents stated this resident needed more help than the staff could give. 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: 6 of 7
Control Number 26-AS-20210917165229
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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Five out of five residents stated that staff provides laundry services at the facility. Two out of five residents stated they do their own laundry. Three out of five residents stated that staff help the residents with laundry when needed.

On 09/23/2021, a total of four staff (S1 – S4) were interviewed. Three out of four staff stated facility provides laundry services for the residents. Three out of four staff stated to assist the residents with their laundry. Three out of four staff stated to assist the residents with laundry when they have an emergency or have an accident. All four staff stated the resident in question was not aware of his hygiene needs due to his diagnosis and staff would clean after him or throw away his defecated pants or assisted him with showers.

Based on record review, the facility provides basic services to include laundry service. Facility staff can provide assistance with bathing and personal needs, as required. Former resident’s physician reports state a capacity to provide own self care to include bathing, dressing, feeding, and toileting. Former resident’s needs and services plan states that the client sometimes need to maintain hygiene and grooming needs. Facility objective and plan was for client to shower at least three times a week.

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.
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: 7 of 7