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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201796
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:51:52 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
08/12/2021 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20210812100330
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: 63DATE:
08/07/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH: Samiha FaourTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff are not properly supervising residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo arrived at the facility to conduct an unannounced complaint investigation visit and met with Samiha Faour.

On 08/12/2021, the Department received a complaint with the above allegations. LPA Marrufo conducted an initial complaint investigation visit on 08/17/2021. LPA Marrufo interviewed 7 residents and 7 staff.

LPA Marrufo obtained copies of 6 facility staff Health Screening Reports. 6 out of 6 staff Health Screening Reports stated the staff were in good overall health and had no known health condition that would create a hazard to the person, client, or other personnel.

A complaint investigation received on 11/16/2021 alleging that there were criminal activities at the facility was determined to be unsubstantiated on 02/23/2022.
See LIC9099-C for more information. Page 1 of 2.
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)
Page: 1 of 2
Control Number 26-AS-20210812100330
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: 08/07/2023
NARRATIVE
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7 out of 7 interviewed residents stated to have not observed any times when the staff did not properly supervise residents.

7 out of 7 interviewed staff stated to have not observed staff not properly supervising residents.

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 22

This report was reviewed with Samiha Faour and a copy of this report was provided.


Page 2 of 2.



END REPORT
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
LIC9099 (FAS) - (06/04)
Page: 2 of 2