275202407-7-2-2026-24-AS-BMIA-DVLVD9-20260702162022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 275202407
Report Date: 07/02/2026
Date Signed: 07/02/2026 04:20:39 PM

Document Has Been Signed on 07/02/2026 04:20 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	MONTEREY BAY GUEST HOME		FACILITY NUMBER:	275202407
ADMINISTRATOR/ DIRECTOR:	EMMANUEL & JENNIFER INNEH		FACILITY TYPE:	735
ADDRESS:	1100 CARSON STREET		TELEPHONE:	(831) 920-1796
CITY:	SEASIDE	STATE: CA	ZIP CODE:	93955
CAPACITY: 22		CENSUS: 13	DATE:	07/02/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:17 AM
MET WITH:	Larry Rimas		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) B. Miranda & H. Vang conducted an unannounced visit today for the facility’s annual inspection. LPAs introduced themselves and was allowed entrance into the facility. LPAs met with Emmanuel Inneh & Larry Rimas. Facility is licensed for 22 residents and has a current census of 13. Water temperature was checked in the kitchen which read at 112.6 degrees Fahrenheit and a common bathroom which read at 110.8 degrees Fahrenheit. Fire Extinguisher still has charge. Smoke and carbon monoxide detectors were tested and in working order. Facility had a fire inspection and testing completed by First Alarm on June 2026 and passed. Emmanuel Inneh Administrator's Certification expires June 28, 2027. Staff files and resident files were reviewed. First aid kit on site. Toxins and cleaning supplies are locked and inaccessible. There is a locked med cart for medications. R1 not being given their Mounjaro injection, facility was not able to explain why the shot was not being given, and stated it was not because the resident refused. LPA observed kitchen walls, cabinets, refrigerators, & freezers not clean or sanitary. Broken tile in women's bathroom & dining area, and cabinets under the sink to have water damage. LPA observing cockroach eggs in the pantry area where clean dishes are kept and spider webs in kitchen cabinet. R1 & R2's medication not being logged correctly. R1 not being given their Mounjaro injection Deficiencies observed were cited during today's inspection per California Code of Regulations, Title 22.

NAME OF LICENSING PROGRAM MANAGER: Alexandria Walton
NAME OF LICENSING PROGRAM ANALYST: Brianna Miranda
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 07/02/2026 04:20 PM - It Cannot Be Edited

Created By: Brianna Miranda On 07/02/2026 at 02:29 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(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, the licensee did not comply with the section cited above due to LPA observed kitchen walls, cabinets, refrigerators, & freezers not clean or sanitary. Broken tile in women's bathroom & dining area, and cabinets under the sink to have water damage, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/09/2026
	Plan of Correction
1 2 3 4	Administrator will areas cleaned and picture verification will be sent to the Dept by POC due date.

Type B

Section Cited

CCR

80076(a)(17)

Food Service

(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, the licensee did not comply with the section cited above due to LPA observing cockroach eggs in the pantry area where clean dishes are kept and spider webs in kitchen cabinet, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/09/2026
	Plan of Correction
1 2 3 4	Administrator will clean the pantry area and picture verification verification will be sent to the Dept.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:

	Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/02/2026 04:20 PM - It Cannot Be Edited

Created By: Brianna Miranda On 07/02/2026 at 03:19 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80075(b)

(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. 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 due to R1 not being given their Mounjaro injection, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/03/2026
	Plan of Correction
1 2 3 4	Adminsitrator will follow-up with R1's Mounjaro medication. Verificaiton of outcome will be sent to the Dept by POC due date.

Section Cited


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

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:

	Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/02/2026 04:20 PM - It Cannot Be Edited

Created By: Brianna Miranda On 07/02/2026 at 03:23 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80075(k)(7)

(k) The following requirements shall apply to medications which are centrally stored: (7) The licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications which is retained for at least one year..... 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 due to R1 & R2's medication not being logged correctly, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/09/2026
	Plan of Correction
1 2 3 4	Administrator will correct centrally stored logs. Verification of corrections will be sent to the Dept.

Section Cited


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

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:

	Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MONTEREY BAY GUEST HOME	FACILITY NUMBER: 275202407
	VISIT DATE: 07/02/2026

NARRATIVE

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LPA is requesting the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication carts, kitchen, and outdoor areas. Bedrooms were furnished with adequate lighting. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Deficiencies observed were cited during today's inspection per California Code of Regulations, Title 22.

LPA is requesting the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing by July 9, 2026.

Exit interview conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Larry Rimas.

NAME OF LICENSING PROGRAM MANAGER: Alexandria Walton
NAME OF LICENSING PROGRAM ANALYST: Brianna Miranda
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

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