435201796-2-23-2022-26-AS-KHOS-CCSMDX-20220323093151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 02/23/2022
Date Signed: 02/23/2022 12:23:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Christine Dolores

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20211116143636

FACILITY NAME:	NUEVA VISTA		FACILITY NUMBER:	435201796
ADMINISTRATOR:	WEINSTEIN, MICHAEL		FACILITY TYPE:	735
ADDRESS:	18225 HALE AVENUE		TELEPHONE:	(408) 465-8280
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	72	CENSUS: 69	DATE:	02/23/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	FAOUR, SAMIHA		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Criminal activities in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced complaint visit to deliver finding of the above allegation. LPA met with Program Coordinator Samiha Faour, Assistant Administrator Justin Lorick, and Administrator Mark Castillo via telephone.

From 11/17/2021 – 12/08/2021, LPA obtained the following documents to include 7 residents Physician Reports, Appraisal Needs and Services Plan, Personnel Roster, and Resident Community Rules.

On 11/17/2021, 7 residents were interviewed. 6 out of 7 residents states they have not heard or witnessed any criminal activities at the facility to include any illegal solicitations. 1 out of 7 residents did not feel comfortable commenting on the topic. 6 out of 7 residents state there is/are resident’s who are using drugs at the facility but are unsure of who. 1 out of 7 residents did not feel comfortable providing information about drug use at the facility. 3 out 7 residents states that staff know about the drug use but are unsure of their plan of action. 4 out of 7 residents did not comment on how staff are addressing the situation. Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20211116143636

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: NUEVA VISTA	FACILITY NUMBER: 435201796
	VISIT DATE: 02/23/2022

NARRATIVE

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From 11/17/2021 – 11/29/2021, 6 staff members were interviewed. 6 out of 6 staff states there are no criminal activities to include illegal solicitations that are occurring at the facility that they have witnessed or heard of. 4 out of 6 staff states they are aware of the drug use at the facility and staff are taking proper measure to address the incident. 2 out of 6 staff states no knowledge of drug use at the facility.

Based on record review, 7 out of 7 resident appraisal needs and services plan are updated for the year of 2021 and are descriptive to address each resident’s needs and how the facility plans to meet those needs. Resident Community Rules indicates alcohol and illegal drugs, including marijuana, are not permitted at Psynergy Programs at any time. Rules addresses the risk of individuals being under the influence at the program to include presenting a threat to self or the mental or physical health and safety of other residents.

The Department has investigated the above allegations. Based on interviews conducted, observation, and records reviewed, the Department has determined that the above allegations is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Deficiencies cited per California Code of Regulations, Title 22.

This report was reviewed with Program Coordinator Samiha Faour, Assistant Administrator Justin Lorick, and Administrator Mark Castillo via telephone. A copy of the report was provided.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC9099 (FAS) - (06/04)

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