435201796-7-21-2023-26-AS-KHOS-CU9GRN-20230731053435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:29:15 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
08/11/2022 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20220811112735

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: 64	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Ethelind Lara		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff did not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding of the above allegation. The facility’s Administrator and management team was attending a training in Sacramento and was unable to meet LPA at the facility. LPA met with Medroom Manager / Manager on Duty, Ethelind Lara.

On 08/11/2022, the Department received the complaint. On 08/16/2022, the initial complaint investigation was conducted.

The following documents were obtained to include the facility’s resident roster, LIC500, staff schedule, resident (R1 – R7’s) physician’s report, needs and services plan, and personal rights form.

It was alleged a resident (R1) was yelled and harassed by staff members at the facility. SEE LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20220811112735

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: 07/21/2023

NARRATIVE

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On 08/16/2022, resident (R1 – R7) were interviewed. Based on interview, 4 out of 7 residents state to have not witnessed staff yell at other residents. 5 out of 7 residents state to have never observed staff harassing or mistreating a resident at the facility.

On 08/16/2022, staff (S1 – S6) were interviewed. Based on interviews, 6 out of 6 staff denied observations of harassment, yelling, or mistreatment of residents.

The Department has investigated the above allegation. Based on interview, record review, and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Medroom Manager / Manager on Duty, Ethelind Lara and a copy of the report was provided.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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