435201796-9-6-2023-26-AS-KHOS-CWFQNC-20231009121855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 09/06/2023
Date Signed: 09/06/2023 03:32:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 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
09/01/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230901124736

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: 66	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Mark Castillo		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff inappropriately spoke about a resident to another resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation. LPA met with Administrator, Mark Castillo.

On 09/01/2023, the Department received a complaint alleging a staff had inappropriately spoke about a resident to another resident in care. On 09/06/2023, the initial complaint investigation was conducted.

Documents were obtained for this investigation to include the resident roster with resident’s emergency contact information, personnel report, staff (S1)’s personnel report, and resident (R1) – (R6)’s physician’s report and appraisal/needs and services plan. SEE LIC9099-C.

On 09/06/2023, 6 residents were interviewed. 5 out of 6 residents has not experienced a staff member inappropriately talk about another resident in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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-20230901124736

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: NUEVA VISTA	FACILITY NUMBER: 435201796
	VISIT DATE: 09/06/2023

NARRATIVE

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On 09/06/2023, 6 residents were interviewed. 5 out of 6 residents has not experienced a staff member inappropriately talk to them about another resident in care. 5 out of 6 residents has not experienced a staff member talk to them about resident (R1).

On 09/06/2023, 2 staff members were interviewed. 2 out of 2 staff members has not observed nor is aware of an incident where staff (S1) talked inappropriately about R1 to another resident. Based on interview, R1 tends to believe that people are saying things to him/her. After follow-up and observation, the incidents were not found to be true.

Based on record review and interview, the reporting party (RP) believed the client was having delusional beliefs about the interaction with the alleged staff (S1). RP states these accusations are not uncommon.

The review of R1’s records confirmed R1 experiences symptoms, and the facility has an objective/plan to address R1’s needs.

The Department has investigated the above allegation. Based on interview, record review and observation the Department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the allegation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Mark Castillo and a copy of the report was provided.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

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