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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201796
Report Date: 08/04/2023
Date Signed: 08/04/2023 04:58:36 PM

Document Has Been Signed on 08/04/2023 04:58 PM - 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: DATE:
08/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Makel AliTIME COMPLETED:
05:05 PM
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
Licensing Program Analyst (LPAs) Christine Dolores arrived unannounced to conduct the facility’s required - 1 Year inspection. LPA met with Assistant Administrator (AA) Makel Ali.

During visit, LPA toured the facility with AA to include the entrance, resident bedrooms, bathrooms, shower rooms, hallways, kitchen program room, multi-purpose room, laundry room, medication room, and kitchen.

All fire exit routes are free and clear of obstruction. Facility temperature maintained from 72 - 77 degrees Fahrenheit. Fire extinguishers last serviced on 06/22/2023. The facility has carbon monoxide detectors present throughout the building. Chemicals and sharp objects observed secured.

LPA and AA entered RM 215, RM 209, RM 208, RM 101, RM 227, and RM 224. Bedrooms observed well-maintained with adequate lighting, beds, linens, dressers, closets and bathrooms.

Hot water temperature located in the 100s Hallway maintained at 123 degrees Fahrenheit. Bathrooms located in the hallways observed with hand washing signs, hygiene products and paper supplies. Shower rooms observed with grab bars and a chair. Women's shower room hot water temperature located in the 200s hallway maintained at 110 degrees Fahrenheit.

The facility’s kitchen contained at least 2 days worth of perishables and 7 days worth of non-perishable foods. Items inside the refrigerator was observed covered and labeled. The facility has clean utensils, plates and cups. Refrigerator temperature maintained at 42 degrees Fahrenheit. SEE LIC809-C.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/04/2023
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
Facility has a complete first aid kit to include tweezers, scissors, bandages, gauze, and a thermometer. LPA reviewed 5 resident (R1 – R5’s) centrally stored medication records with staff (S1).

Posters observed throughout the facility to include the facility's evacuation map, COVID-19 related posters, activity calendar, and weekly menu.

Due insufficient time, LPA will return another day for the annual continuation.

This report was reviewed with Assistant Administrator Makel Ali and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 10