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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202549
Report Date: 11/03/2022
Date Signed: 11/04/2022 09:41:53 AM

Document Has Been Signed on 11/04/2022 09:41 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 HOME #2FACILITY NUMBER:
275202549
ADMINISTRATOR:INNEH, EMMANUELFACILITY TYPE:
735
ADDRESS:645 WILLIAMS ROADTELEPHONE:
(831) 975-4970
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 40CENSUS: 38DATE:
11/03/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Emmanuel InnehTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility on 11/03/22 at 11:00 a.m.to conduct a Case Management- Health Checks visit. LPA met with Administrator Emmanuel Inneh and explained the purpose of today's visit.

LPA Hurt received an incident report from the facility documenting on 11/02/2022 Resident 1 was observed by facility staff 1 on the ground outside of the facility, he appeared to have been hit by a car. Facility staff 1 observed the driver of the vehicle standing over Resident 1 calling 911 for assistance. Resident 1 was alert and responsive, but was transported by ambulance to the local hospital. Resident 1 is currently in the hospital being monitored. Resident 1 is ambulatory and independent and the incident occurred while he was outside of the facility. Facility staff immediately reminded all residents to use the proper crossing lights, and crosswalks when crossing streets. Facility Administrator had a follow-up meeting with all residents on 11/02/2022 to discuss safety issues, and the importance of using legal signs when crossing the street.

Upon further review of Resident 1's documentation 602 Physician's Report does state they are ambulatory, but is not clear if he allowed to leave the facility unassisted. Administrator Emmanuel Inneh will provide clarification to LPA Hurt, and this will be re visited documentation is not provided.

At this time No deficiencies are being cited today Per Title 22 Regulations.

Exit Interview conducted with Emmanuel Inneh and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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