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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201796
Report Date: 07/22/2022
Date Signed: 07/25/2022 08:21:29 AM

Document Has Been Signed on 07/25/2022 08:21 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
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: 67DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Juan CooperTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection to focus on infection control. LPA met with Administrator, Juan Cooper.

During visit, LPA toured the facility inside and outside. All fire exits routes are free and clear of obstructions. Staff observed to be wearing a face mask.

Facility has a designated screening area to include symptom screening and temperature check. Hand sanitizer is available upon request and throughout the facility. Bathrooms observed to be supplied with hygiene products, paper supplies, and hand washing sings. LPA observed facility's supply of trash can with lids. LPA recommended to place trash can with lids in the client's bedrooms and bathrooms. Facility clean and disinfect multiple times daily and as needed. Facility cohorts communal dining and activities. The following signs observed to include social distancing, symptoms of COVID-19, and mask required. LPA reviewed facility's policies and procedures to include visitation, training, isolation, and staffing. Staff have conducted N95 fit-testing and will be renewing fit-testing this year.

No citations were issued per the California Code of Regulations, Title 22. Advisory note provided.

The following documents were requested: facility's change of Administrator, LIC-500, and LIC610D by 07/26/2022.

This report was reviewed with Administrator, Juan Cooper and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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