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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708454
Report Date: 01/25/2023
Date Signed: 01/26/2023 04:47:12 PM

Document Has Been Signed on 01/26/2023 04:47 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:SARATOGA ADULT CARE CENTERFACILITY NUMBER:
430708454
ADMINISTRATOR:SUSAN HUFFFACILITY TYPE:
775
ADDRESS:19655 ALLENDALE AVENUETELEPHONE:
(408) 868-1262
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 30CENSUS: DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rajvir KaurTIME COMPLETED:
03:38 PM
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Licensing Program Analyst (LPA) Ryker Heberle conducted an unannounced Required - 1 Year visit on 01/25/2023 at 02:59pm and met with Operations Manager, Rajvir Kaur (S1).

LPA toured the facility, including the reception area, kitchen, multipurpose room, staff break, 2 administrative offices, 2 bathrooms, and back yard. Clients are currently attending the program.

No prohibited items noted in facility. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. No prohibited items were observed on the premises. Food is not prepared for the clients at the facility, and is primarily catered or prepared elsewhere. First aid kit was observed. Fire extinguishers observed to have been inspected in March of 2022. Facility is equipped with smoke detector and carbon monoxide detector. Disaster drill was last conducted in October of 2022

All restrooms stocked with paper towels. Hand washing signs were observed in all bathrooms. Facility water temperature measured at 95.2 *F. Bathrooms were equipped with grab bars and non skid floors. Facility temperature was noted to be 70*F Social distancing signs observed to be posted in all public areas. Facility was observed to have a room for clients to isolate if symptoms manifest. Vaccination rate for staff and clients is currently at 100%.

No deficiencies cited during today's visit. Advisory notes issued. This report was reviewed with Rajvir Kaur and a copy of the signed report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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