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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202407
Report Date: 03/23/2023
Date Signed: 03/24/2023 09:32:56 AM

Document Has Been Signed on 03/24/2023 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HOMEFACILITY NUMBER:
275202407
ADMINISTRATOR:EMMANUEL & JENNIFER INNEHFACILITY TYPE:
735
ADDRESS:1100 CARSON STREETTELEPHONE:
(831) 920-1796
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY: 22CENSUS: 18DATE:
03/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:Administrator- Emmanuel InnehTIME COMPLETED:
02:00 PM
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On 3/23/23 at 12:08 p.m. Licensing Program Analyst (LPA) B. Miranda conducted an unannounced case management visit regarding an incident report received on 3/1/23 from the facility. LPA B. Miranda was greeted by staff member and allowed entry into the facility. LPA explained the reason for the visit and Administrator (AD) Emmanuel Inneh was contacted and arrived later.

LPA toured the facility, residents were in their rooms or outside in the patio area. Some residents were eating lunch and interacting with staff when LPA arrived.

LPA asked AD if there was a procedure in place regarding residents who may have suicidal thoughts/actions. AD stated the facility is not equipped to meet the needs of suicidal residents. AD agreed there will be procedures/policy implemented in case future situations arise. AD stated the admission agreement will also be revised.

No deficiencies were noted at this time and no citations were issued.

Exit interview was conducted and a copy of the report was provided to AD.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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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