<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 06/14/2024
Date Signed: 06/14/2024 09:30:35 AM

Substantiated


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
11/14/2023 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20231114122959
FACILITY NAME:NUEVA VISTAFACILITY NUMBER:
435201796
ADMINISTRATOR:WEINSTEIN, MICHAELFACILITY TYPE:
735
ADDRESS:18225 HALE AVENUETELEPHONE:
(408) 465-8280
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:72CENSUS: 70DATE:
06/14/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Ernest GibsonTIME COMPLETED:
09:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Absent of supervision resident overdose on drugs and died in the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding for the above allegation. LPA met with Assistant Administrator II, Ernest Gibson.

On 11/14/2023, the Department received a complaint alleging a lack of supervision which resulted in resident (R1)’s death in the facility due to drug overdose. On 11/15/2023, the initial complaint investigation was conducted.

Based on resident interview, on 11/13/2023, R1’s roommate (R2) stated that during their community outing, R1 found drugs at a bus stop and planned to use it. When they came to the facility, the staff asked them to empty their bags and pockets as normal. According to R2, at approximately 1800 hours, R1 went into the bathroom and asked R2 if he/she wanted to smoke the drugs but R2 declined.
PAGE 1 OF 3.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
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 4
Control Number 26-AS-20231114122959
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: 06/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The review of facility records show that, R1 was marked in attendance to receive dinner which was served between 1730 and 1830 hours. Staff (S1) stated he/she remembered R1 picking up his/her medications around 1745 hours. Staff (S2) stated he/she remembered seeing R1 during snack time around 2015 hours.

Between 2015 to 2200 hours, R1 was unaccounted for because the facility did not start bed checks until after 2200 hours. R2 indicated that he/she told staff (S2) that R1 was in the bathroom during a room check at approximately 2200 hours.

S2 stated the observation of R1’s bathroom light turned on, and the appearance of R1's bathroom being occupied during S2’s room check at 2200 hours. S2 did not check if anyone was in the bathroom.

Around 0000 hours, S3 found R1 lying on the floor of the the bathroom. Staff immediately called 911.

Based on review of the police report records, R1's body was in rigor mortis by the time the officers arrived. According to ncbi.nlm.nih.gov, rigor mortis "appears approximately two hours after death in the muscles of the face, progresses to the limbs over the next few hours, completing between six to eight hours after death". R1 was pronounced deceased.

Based on staff interview, S1 believed S2 was not thorough with his/her bed check because S2 should have used common sense to knock on the bathroom door and look underneath the door frame if the staff did not see R1 in bed. S1 stated that if S2 had conducted a proper bed check, then staff could have given a Narcan or provided aid sooner.

The Department has investigated the above allegation. Based on record review, interview, and observation the preponderance of evidence standard has been met, therefore, the above allegation is SUBSTANTIATED. A deficiency was cited per California Code of Regulations, Title 22. See LIC9099-D.

PAGE 2 OF 3.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 26-AS-20231114122959
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: 06/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
An immediate civil penalty of $500.00 is being assessed against the facility today for violation resulting in the death to a resident in care. SEE LIC421M.

An additional Civil Penalty for violation resulting in a resident’s death is pending review.

This report was reviewed with Assistant Administrator II, Ernest Gibson and a copy of the report and appeal rights was provided.

PAGE 3 OF 3.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20231114122959
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/15/2024
Section Cited
CCR
80065(a)
1
2
3
4
5
6
7
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee has already provided staff training on proper bed checks and increased the bed check frequency throughout the night shift. Licensee will provide LPA Dolores the training document via email by POC due date.
8
9
10
11
12
13
14
Based on interview and record review the licensee failed to ensure staff (S2) was competent to provide the service necessary to meet resident (R1)’s needs by not providing a thorough bed check which poses an immediate health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type A
07/10/2024
Section Cited
CCR
80078(a)
1
2
3
4
5
6
7
(a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
THIS PAGE WAS AMENDED FROM VISIT ON 06/14/2024. Licensee will submit in writing the facility's procedures when conducting room checks on the residents to ensure their safety. Licensee will submit the POC to LPA Dolores by POC due date.
8
9
10
11
12
13
14
Based on interview and record review the licensee did not ensure proper care and supervision was provided to meet R1's needs, the staff did not conduct a thorough bed check and resident overdosed and was found deceased in the facility, which poses an immediate health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Administrator was informed the civil penality will be assessed on this citation.
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: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4