435201796-7-12-2023-26-AS-KHOS-CURN9G-20230816101556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 07/12/2023
Date Signed: 07/12/2023 11:27:08 AM

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
05/13/2020 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20200513115437

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:	07/12/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Crystal Roberts		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Illegal eviction
Facility staff did not provide resident's SNF with resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Crystal Roberts, Residential Services Director.

On 05/13/2020, the Department received a complaint with the above allegations. LPA Marrufo conducted an initial complaint investigation visit on 04/22/2020.

LPA Marrufo obtained copies of resident R1’s Identification and Emergency Information form, R1’s updated Physician’s Reports for R1 from 04/30/2020 and 05/06/2020, and the facility license.

R1’s Identification and Emergency Information form listed conservator (C1) as R1’s conservator and case manager (CM1) as R1’s case manager.
See LIC9099-C for more information. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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 3

Control Number 26-AS-20200513115437

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: 07/12/2023

NARRATIVE

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The facility license states the facility can only accept ambulatory residents.

R1’s updated Physician’s Report from 04/30/2020 stated R1 is non-ambulatory. R1’s updated Physician’s Report from 05/06/2020 stated R1 is ambulatory. These two Physician’s Reports were made at a Skilled Nursing Facility (SNF) where R1 was staying. R1’s admission Discharge Transfer Form states R1 returned to the facility on 06/11/2020.

During interview, C1 stated R1 stayed at a hospital and transferred to a SNF on 04/09/2020 and returned to Nueva Vista on 06/11/2020.

During interview, the facility Program Director (PD) stated to have initially not accepted R1 back to the facility because R1 was non-ambulatory, and the facility license limits the facility to accept only ambulatory residents. PD stated that when R1’s Physician’s Report stated that R1 had become ambulatory, R1 was not admitted into the facility until 06/11/2020 because the staff at the Skilled Nursing Facility (SNF) where R1 was staying were not completing R1’s admission documentation correctly. PD stated to provide education to the SNF staff on how to properly complete the admission documentation to R1 and had to explain to the SNF staff that the documentation was required by California state regulations.

During interview, C1 stated that the reason it took R1 from 05/06/2020 until 06/11/2020 to return to the facility is because there may not have been an available bed at the facility until 06/11/2020.

PD stated during interview that since R1’s condition had changed from R1’s stay at the hospital and transfer to the SNF, that the Nueva Vista doctor could not provide medications based on R1’s prior condition.

Page 2 of 3.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20200513115437

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: 07/12/2023

NARRATIVE

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R1’s Physician’s Report from 04/30/2020 contains a medication list for R1.

C1 stated that there had been issues with R1 obtaining new medications at the SNF because the SNF did not have an on-site psychologist. C1 stated that Nueva Vista’s psychologist was able to re-prescribe R1’s medications.

Based on information from interviews conducted with staff and witnesses, 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 Residential Service Director Crystal Roberts and a copy of the report was provided.

Page 3 of 3. END REPORT.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3