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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202407
Report Date: 04/24/2024
Date Signed: 04/24/2024 07:19:51 PM

Substantiated


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
03/28/2024 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240328152333
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: 14DATE:
04/24/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Staff Larry RimasTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not prevent a lice outbreak from occurring in the facility
INVESTIGATION FINDINGS:
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On 4/24/24 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver the findings for the allegation(s) listed above. LPA introduced herself and explained the reason for the visit. Licensee Emmanuel Inneh was contacted and report was reviewed with licensee via phone.

The facility was not toured at this time due to the purpose of the visit was to deliver findings for the allegation(s) listed above.

1. The Department investigated the allegation: Staff did not prevent a lice outbreak from occurring in the facility. Multiple interviews were conducted and records reviewed at the facility on 4/2/24. There was previously an issue with lice in November 2023, there were no procedures put in place to prevent an infestation of lice. Licensee stated the residents case workers were contacted and waited for the case workers response to handle the infestation. Licensee also stated resident's bedding is being washed weekly to help prevent
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
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 3
Control Number 24-AS-20240328152333
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: 04/24/2024
NARRATIVE
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further infestation, but bedding would not be washed as a preventative measure until residents have begun treatment for lice.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, & Chapter 1, are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report LIC9099 , LIC9099D, and appeal rights were provided to Staff Larry Rimas

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20240328152333
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2024
Section Cited
CCR
80087(a)(1)
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80087 Buildings 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.
(1) The licensee shall take measures to keep the facility free of flies and other insects.
This requirement is not met as evidenced by:
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Licensee attended class to prevent lice. Resident's will be monitored and wash bedding 2 times a week. Verification will be sent to LPA
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Based on observation/ interview/ record review the licensee failed to prevent in insect infestation at the facility. Previously there was a resident at the facility with severe head lice since then there have been no procedures put in place to prevent lice at the facility. This poses a potential health, safety, or personal rights risk to residents 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: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3