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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202407
Report Date: 06/23/2023
Date Signed: 06/23/2023 04:16:27 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2023 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230316145640
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:
06/23/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Caregiver- Larry RimasTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff misplaced resident's medication
Staff are not reporting unusual incidents to resident's conservator
INVESTIGATION FINDINGS:
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On 6/23/23 at 4:00 p.m. Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to deliver the finding of the allegations listed above. LPA was greeted by staff and allowed entry into the facility. LPA requested Administrator (AD) be contacted, AD authorized caregiver Larry Rimas to sign.

1. The Department investigated the allegation: Staff misplaced resident's medication. LPA interviewed 3 residents and 2 staff members. LPA was given conflicting information during the interviews. Interviewees could not confirm medications were misplaced.

2. The Department investigated the allegation: Staff are not reporting unusual incidents to resident's conservator. LPA interviewed 3 residents and 2 staff members. LPA reviews regulation and did not find allegation #1 as being required to be reported to conservator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
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 2
Control Number 24-AS-20230316145640
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MONTEREY BAY GUEST HOME
FACILITY NUMBER: 275202407
VISIT DATE: 06/23/2023
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated

Exit interview was completed and a copy of LIC9099 report was provided to Caregiver Larry.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2