435201057-10-28-2024-26-AS-KHOS-DC2NCJ-20241217092050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201057
Report Date: 10/28/2024
Date Signed: 10/28/2024 02:00:15 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
01/10/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220110162643

FACILITY NAME:	SARATOGA RETIREMENT COMMUNITY		FACILITY NUMBER:	435201057
ADMINISTRATOR:	SARAH STEL		FACILITY TYPE:	741
ADDRESS:	14500 FRUITVALE AVENUE		TELEPHONE:	(408) 741-7100
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	418	CENSUS: 88	DATE:	10/28/2024
		UNANNOUNCED	TIME BEGAN:	11:44 AM
MET WITH:	Rubina Banwait		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff failed to seek medical attention for resident in a timely manner
Staff failed to meet resident's needs
Staff speaks inappropriately to residents

INVESTIGATION FINDINGS:

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On 10/28/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Clinical Services Supervisor, Rubina Banwait and explained the purpose of the visit.

Regarding the allegation of Staff failed to seek medical attention for resident in a timely manner & staff failed to meet resident's needs, reporting party (RP) stated that on 12/25/2021 at 8am a staff member (refused to provide name) went to a resident’s (R1) room and noticed that R1 was not feeling good as had symptoms of a stroke and one side of her body was numb. The staff immediately called an on-duty nurse (S1) via radio to evaluate the resident ASAP. S1 came and evaluated the resident but failed to seek any medical attention for R1 in a timely manner. The resident was sent to the hospital approximately 4 hours after the incident.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024

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-20220110162643

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: SARATOGA RETIREMENT COMMUNITY	FACILITY NUMBER: 435201057
	VISIT DATE: 10/28/2024

NARRATIVE

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Based on records review, on R1s progress notes, R1 just came back to the facility on 12/25/2021 after being sent to the hospital on 12/24/2021 for a fall. From 12/25/2021, there were several logs in the note about observation of resident. At 9:54am, R1 came back from hospital, alert and responsive. Encouraged to increase fluid intake. Alert charting initiated. At 4:58pm, R1 was observed to be in the sofa, alert and responsive, no respiratory distress noted, R1 stated no pain, no nausea or vomiting at this time. On 12/26/2021, at 6:34am, R1 was observed to be fine, shows confusions and stated that “something on his/her legs not normal” and denied pain. At 10:13am, a note was entered for feet treatment. At 11:46am, R1 is participating in activities, alert and responsive, no respiratory distress noted. R1 stated no pain, no nausea or vomiting at this time, mentioned having a slight headache. Care staff notified R1 is having difficulty walking. There is a weakness noted on the left leg. At 2:03pm, Care staff notified that they were trying to transfer R1 from wheelchair to bed. R1 is unable to stand and care staff. R1 was assessed, has hard time to move left leg due to weakness. There is some weakness on her left hand noted as well. 911 was called and R1 was sent to hospital.

LPA was able to interview eight staff members. S1 stated that when R1 Complains of leg pain, they ask the doctor as to what medication can be given. S2 mentioned that there are no issues with care for R1, never complains but refuses care sometimes. 911 was called right away when incident happened. S3, S5 and S7 all mentioned that they call a nurse to assess when something happens.

LPA is not able to confirm the date provided by the complainant since there is no form of contact provided. A co-complainant also called but the same information was provided.

Regarding the allegation of staff speaks inappropriately to residents, the co-complainant (CC) stated that S1 does not help any of the residents, but instead spends time on his/her phone shopping online. The RP states that when residents call upon S1 for help, S1 yells at them. CC states that staff can hear S1 yelling at residents on the radio. The RP states that S1 does not care about the residents or their well being.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20220110162643

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: SARATOGA RETIREMENT COMMUNITY	FACILITY NUMBER: 435201057
	VISIT DATE: 10/28/2024

NARRATIVE

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*** This is an amended report ***

According to interviews of the 8 staff members, all mentioned of not being aware of any inappropriate treatment of residents by the staff. LPA was able to interview three residents and all mentioned that they are treated fine and are happy here in the facility. R2 mentioned that he/she is treated well by the staff, no one is inappropriate with him/her. R3 stated that they always come and help right away whenever he/she presses the pendant. R4 also mentioned that staff here are really nice and helps a lot when needed.

Based on interviews, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC9099 (FAS) - (06/04)

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