435201796-8-7-2023-26-AS-KHOS-CUWM6A-20230821091938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:53:55 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
07/29/2021 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20210729095916

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: 63	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Samiha Faour		TIME COMPLETED:	04:12 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mismanage resident's money
Staff do not allow resident to leave the facility
Resident was physically assaulted while in care
Staff is not adhering to resident's needs and services plan
Staff is not providing an adequate amount of food to residents
Staff does not accord privacy to resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

R1’s Physician’s Report states R1 is able to leave the facility unassisted.

R1’s Admission Agreement states on Page 16: “Sign In/Sign Out Policy: All residents will be required to sign in and out when leaving the facility at any time, to assist the facility in ensuring the safety of all clients. The sign in/sign out sheet should be filled out completely.”

LPA Marrufo obtained copies of the facility Resident Sign In/Sign Out Sheets from 06/30/2021 to 07/31/2021. LPA Marrufo reviewed the Sign In/Sign Out sheets but did not find an entry for R1. LPA Marrufo observed there to be multiple residents whose names were recorded in the Sign In/Sign Out sheets.

See LIC9099-C for more information. Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 26-AS-20210729095916

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: 08/07/2023

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

On 07/19/2023, LPA Marrufo interviewed staff S1 and S2. S1 and S2 stated that the facility requires residents to complete the Sign In/Sign Out Sheet when leaving and entering the facility. S1 and S2 stated to have not observed any incidents in which the facility staff did not allow a resident to leave the facility.

6 out of 8 interviewed residents stated the facility allows residents to leave the facility. 1 out of 8 interviewed residents stated the facility does not allow residents to leave the facility. 1 out of 8 interviewed residents stated to not know if the facility allows residents to leave the facility.

7 out of 7 staff stated that the facility allows residents to leave the facility.

Neither R1’s nor R2’s Appraisal/Needs and Services Plans state that they have physically aggressive behaviors towards others.

On 08/17/2021, LPA Marrufo interviewed residents R1 and R2. During interview, R1 stated R2 physically assaulted R1 on two occasions. R1 stated on the first occasion, R2 swung at and hit R1’s head around 11 PM or 1 AM at night, although R1 did not specify the date. R1 stated on another occasion, R1 and R2 wrestled against each other. R1 stated to have not obtained bruises or fractures from R2 during either occasion.

R2 stated R1 and R2 were once roommates. R2 stated that about 2-3 months prior, R1 tried to punch R2, but R2 continued to move out of the way as R1 attempted to punch R2. R2 stated that R1 punched R1’s own self while trying to punch R2. R2 stated R1 never landed a punch on R2. R2 stated to have never struck back at R1. R2 stated facility staff moved R2 into a new bedroom with new roommates.

3 out of 8 interviewed residents stated residents have been assaulted while in care. 4 out of 8 interviewed residents stated residents have not been assaulted while in care. 1 out of 8 interviewed residents stated to not know if residents have been assaulted while in care.

Page 2 of 4.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 26-AS-20210729095916

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: 08/07/2023

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

1 out of 7 interviewed staff stated to have known of an incident in which R1 and R2 were involved in a physical altercation with each other, but the incident was not witnessed by any staff or other residents. The staff stated to have not witnessed the incident, but to have been informed about it at a staff meeting. 1 out of 7 interviewed staff mentioned another incident in which a resident tried to hit another resident. 5 out of 7 staff stated to have never observed a resident assaulted while in care.

On 08/03/2021, LPA Marrufo interviewed 8 residents, including R1, and 6 staff. During interview, R1 did not specify how the facility staff did not follow R1’s Appraisal/Needs and Services Plan.

5 out of 8 interviewed residents stated the facility staff adhere to residents’ needs and services plans. 2 out of 8 interviewed residents stated the facility does not adhere to residents’ needs and services plans. 1 out of 8 interviewed residents stated to not know if staff adhere to residents’ needs and services plans.

7 out of 7 interviewed staff stated to have not observed staff not adhering to a resident’s needs and services plan.

R1’s Admission Agreement states the following on Page 2: “Meals: Residents are entitled to three (3) nutritious and well-balanced meals and snacks daily, including some special diets if prescribed by a physician.”

R1’s Physician’s Report states that R1 does not require a special diet.

On 07/19/2023, LPA Marrufo observed the lunch meal service at the facility. LPA Marrufo interviewed staff S3, the facility kitchen chef, who stated residents are only allowed one serving of food unless the resident has a doctor’s note requesting second servings for each meal.

LPA Marrufo observed plates served with salmon, white rice, and broccoli. During meal service, LPA Marrufo interviewed 7 residents during the meal service. 5 out of the 7 residents stated the plates were served with an adequate amount of food. 2 out of the 7 residents stated the plates did not have an adequate amount of food. 7 out of 7 residents stated the facility does not allow residents to ask for second servings of food.

Page 3 of 4.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 26-AS-20210729095916

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: 08/07/2023

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

During visit on 08/03/2021, 6 out of 8 interviewed residents stated the facility provides an adequate amount of food. 2 out of 8 residents stated during interviewed stated the facility does not provide adequate amounts of food.

6 out of 7 interviewed staff stated the facility provides adequate amounts of food to the residents. 1 out of 7 interviewed staff stated the facility does not provide adequate amounts of food.

On 08/07/2023, LPA Marrufo interviewed current Administrator (ADM) Mark Castillo. ADM stated that the facility serves meals according to the serving sizes required by California Code of Regulations Title 22. He stated the facility does not offer second servings to residents because doing so would require the preparation of too much food, but each meal meats the regulated serving size requirements. ADM stated residents are served three meals a day as well as snacks three times a day. LPA Marrufo observed a snack of a cantaloupe milkshake being served to residents. LPA also observed water jugs available to residents. ADM stated some residents have a doctor’s order for food allergies and staff will make them meals to accommodate their food allergies. ADM also stated some residents have doctor’s orders for a second serving of meals.

On 08/03/2021, LPA Marrufo interviewed 8 residents, including R1, and 6 staff. During interview, R1 stated that many residents walk into other resident’s rooms.

6 out of 8 interviewed residents stated that the staff accord privacy to the residents. 1 interviewed resident stated to not know if the staff accord privacy to the residents. As stated previously, R1 stated that facility staff do not accord privacy to the residents.

7 out of 7 interviewed staff stated to have not observed a time when staff did not accord privacy to a resident.
Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.No Deficiencies cited under California Code of Regulations Title 22. This report was reviewed with Samiha Faour and a copy of this report was provided.

Page 4 of 4. END REPORT.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 6