Community Care Licensing

Document Has Been Signed on 10/12/2023 10:37 AM - It Cannot Be Edited

FACILITY NAME:	MONTEREY BAY GUEST HOME		FACILITY NUMBER:	275202407
ADMINISTRATOR:	EMMANUEL & JENNIFER INNEH		FACILITY TYPE:	735
ADDRESS:	1100 CARSON STREET		TELEPHONE:	(831) 920-1796
CITY:	SEASIDE	STATE: CA	ZIP CODE:	93955
CAPACITY: 22		CENSUS: 18	DATE:	09/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Administrator- Emmanuel Inneh		TIME COMPLETED:	04:30 PM

SUPERVISORS NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type A

Section Cited

HSC

1503.2

Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs tested Carbon monoxide readers which were not working. Administrator did not have test report for smoke detectors.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	Batteries will be replaced in carbon monoxide readers or new ones will be bought. Smoke detectors report will be submitted to LPA.

Type A

Section Cited

CCR

80087(a)

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Kitchen and refrigerators need to be cleaned, Mold in bathrooms and laundry floors (fecal matter) need to be cleaned. Outside sink area needs to be cleaned. Screens that are torn need to be replaced.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	A plan needs to be submitted to LPA with a time frame indicating completion.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type A

Section Cited

CCR

80087(g)

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Lock on closest does not work and needs to be replaced. LPAs observed door not locked and staff using tool to unlock door.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	Administrator will replace lock to closet. Receipt and picture of new lock on door will be sent to LPA.

Type A

Section Cited

CCR

80088(e)(1)

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients 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:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Water temperature should be within 105-120 degrees F. LPA observed water temperature in men's bathroom to be 132.2 degrees F.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	Administrator will correct water heater and provide picture to LPA.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type A

Section Cited

CCR

80075(f)

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & record review, the licensee did not comply with the section cited above i which poses an immediate health, safety or personal rights risk to persons in care. LPA reviewed training and there is no current training on file.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	Administrator will provide time frame for training to be completed.

Type A

Section Cited

CCR

80076(a)(1)

(a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan -Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed expired milk and non-perishable food items to be expired.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	Administrator will provide a plan to prevent expired food being kept in the facility.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type A

Section Cited

CCR

80092.1(h)

(h) The licensee shall ensure that facility staff receive instruction from the client's physician or other licensed professional to recognize objective symptoms observable by a lay person, and how to respond to that client's health problems, including who to contact. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.Facility does not have a form on file for resident's PRN/OTC.
	POC Due Date: 09/27/2023
	Plan of Correction
1 2 3 4	Order form fro resident's doctors needs to be obtained. Adminitrator will follow up with doctor's office and obtain order form. Timeframe will be provided to LPA.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type B

Section Cited

CCR

85095.5(a)

(a) A licensee shall ensure that infection control practices are maintained as follows:  This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Facility does not have infections control plan on file at the facility.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will submit infection control plan to LPA.

Type B

Section Cited

CCR

80075(h)(1)

(h) There shall be at least one person capable of and responsible for communicating with emergency personnel in the facility at all times. The following information shall be readily available: (1) The name, address and telephone number of each client's physician and dentist, and other medical and mental health providers, if any. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Not all residents have a completed physician report on file.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will have physician reports completed and up to date for all clients.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type B

Section Cited

CCR

80088(b)

(b) All window screens shall be in good repair and be free of insects, dirt and other debris. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Screens were torn or missing. Powder to repel insects were placed along resident's walls.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Screens will be replaced and powered removed from resident's room. Pictures will be provided to LPA.

Type B

Section Cited

CCR

80088(f)(1)

(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Trash cans do not have tight fitting lids.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will have lids placed on trash.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type B

Section Cited

CCR

85088(c)(1)

(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (1) An individual bed, except that couples shall be allowed to share one double or larger sized bed, maintained in good repair, and equipped with good bed springs, a clean mattress and pillow(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed 2 beds to not be in good repair.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will replace or restore mattress, and provide verification.

Type B

Section Cited

CCR

85088(c)(4)(B)

(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and wash cloths. (B) The use of common towels and washcloths shall be prohibited. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed towels on one of the women's bathrooms that appeared to be used multiple times. Paper towels were not provided in bathrooms.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will provide a plan to not have towels used multiple times and provide paper towels in the bathrooms.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type B

Section Cited

CCR

80077.3(a)(3)(C)

(C) Following the disaster and mass casualty plan specified in Section 80023, fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all facility staff who provide or supervise client care and supervision. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Facility was unable to provide a log for fire and earthquake drills completed.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will provide procedure put into place regarding drills and provide vrification to LPA.

Type B

Section Cited

CCR

80020(a)

(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Facility does not have sketch on file at the facility. LPAs were not able to verify fire exit and clearances.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will provide sketch of facility and kept sketch accessible at the facility.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type B

Section Cited

HSC

1537.1(a)

(a) A licensee of a residential facility serving adults that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for client use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Facility does not have a device readily accessible to residents for use.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will have device for residents to use when requested.

Type B

Section Cited

CCR

80076(a)(17)

(a) In facilities providing meals to clients, the following shall apply: (17) All kitchen, food preparation, and storage areas shall be kept clean, free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents, and other vermin. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed kitchen to be cluttered and not clean. LPAs observed debris, litter, and rubbish.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will provided pictures of cleaned kitchen and refrigerators.

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023

Link to Parent Document Below:

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2023

Type B

Section Cited

CCR

80092.1(l)

(l) All training shall be documented in the facility personnel files. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs did not observe current training in the staff files.
	POC Due Date: 10/03/2023
	Plan of Correction
1 2 3 4	Administrator will provide updated staff training.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Brenda Chan LICENSING EVALUATOR NAME: Brianna Miranda LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023