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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201796
Report Date: 07/12/2023
Date Signed: 07/12/2023 11:30:43 AM

Document Has Been Signed on 07/12/2023 11:30 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: 66DATE:
07/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Crystal RobertsTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Crystal Roberts, Residential Services Director. The purpose of the visit was to address issues related to a complaint visit that occurred on the same day.

LPA Marrufo requests that the facility develops a plan for staff to follow when a resident has been discharged to a hospital or other facility and is waiting for a new placement at another facility. The plan should include what the facility will do if a resident is being discharged from a hospital or other medical facility and is still waiting for a new placement. The plan should also include how Nueva Vista will do its due diligence to ensure the resident still has access to the resident’s prescribed medications and communicate with the staff at the other facility or hospital about all placement issues related to the resident.

LPA Marrufo requests that the facility submit this plan by 07/19/2023 for the Department to review.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Residential Services Director Crystal Roberts and a copy of the report was provided.
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.

LIC809 (FAS) - (06/04)
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