435201796-8-7-2023-26-AS-KHOS-CUWKFF-20230821075150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:59:04 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
07/27/2021 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20210727113944

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: 63	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Samiha Faour		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unlawful eviction

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Marrufo conducted an unannounced complaint investigation visit and met with Samiha Faour.

On 07/27/2021, the Department received a complaint with the above allegation. On 08/03/2021, the Department conducted an initial complaint investigation visit. On 08/03/2021, LPA Marrufo conducted an interview with staff S1. S1 stated residents R1 and R2 were recently sent out to the hospital. LPA Marrufo made attempted telephone interviews with resident R1 and R2’s conservators but was not able to reach them.
Based on information from interviews conducted with staff, 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 22This report was reviewed with Samiha Faour and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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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