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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202549
Report Date: 06/20/2022
Date Signed: 06/20/2022 07:40:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/16/2022 and conducted by Evaluator Lady Cabrera
COMPLAINT CONTROL NUMBER: 24-AS-20220616110849
FACILITY NAME:MONTEREY BAY GUEST HOME #2FACILITY NUMBER:
275202549
ADMINISTRATOR:INNEH, EMMANUELFACILITY TYPE:
735
ADDRESS:645 WILLIAMS ROADTELEPHONE:
(831) 975-4970
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:40CENSUS: 37DATE:
06/20/2022
UNANNOUNCEDTIME BEGAN:
07:25 PM
MET WITH:Marisa Licup, CaregiverTIME COMPLETED:
07:50 PM
ALLEGATION(S):
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Illegal Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) S. Doucette and L. Cabrera conducted the complaint investigation visit to the facility.

During the course of this complaint investigation LPAs interviewed Administrator and client and reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. Facility illegally evicted client and did not meet Eviction Procedures. Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 6), are being cited on the attached LIC 9099D.”)

Exit interview was conducted. Facility was provided with a copy of this report and Appeal Rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
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-20220616110849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MONTEREY BAY GUEST HOME #2
FACILITY NUMBER: 275202549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2022
Section Cited
CCR
80068.5
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80068.5 Eviction Procedures(a) Except for children's residential facilities, the licensee may, upon 30 days written notice to the client, evict the client only for one or more of the following reasons:
This requirement was not met as evidenced by:
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Administrator shall review Title 22, Division 6, Chapter 6, Section 85068.5: Evictions Procedures. Administrator shall provide in writing that the regulation has been read and understood by 6/21/2022.
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Based on observation, record review and interviews, the Licensee did not serve the resident with a proper 30-day eviction notice, which poses a Immediate Health, Safety and Personal Rights risk to persons 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: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2