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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202549
Report Date: 05/06/2024
Date Signed: 05/08/2024 11:19:39 AM

Document Has Been Signed on 05/08/2024 11:19 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MONTEREY BAY GUEST HOME #2FACILITY NUMBER:
275202549
ADMINISTRATOR/
DIRECTOR:		INNEH, EMMANUELFACILITY TYPE:
735
ADDRESS:645 WILLIAMS ROADTELEPHONE:
(831) 975-4970
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 40CENSUS: DATE:
05/06/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Licensee,Emmanuel InnehTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted a Case Management visit. LPA met with facility Facility Licensee, Emmanuel Inneh, and explained the purpose of today's visit.


LPA Hurt provided Licensee Emmanuel Inneh with link to Contact Us - Institute on Aging (ioaging.org) for possible additional funding. LPA Hurt spoke with Monterey County Ombudsman concerning the placement of Resident 1. LPA Hurt spoke with San Jose Licensing staff regarding Resident 1's placement. LPA Hurt spoke briefly with Resident 1, and they appears to be safe, and doing well at the facility.


Exit interview conducted with facility Licensee, Emmanuel Inneh, and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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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