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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201057
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:15:44 PM

Document Has Been Signed on 07/28/2022 03:15 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 RETIREMENT COMMUNITYFACILITY NUMBER:
435201057
ADMINISTRATOR:SARAH STELFACILITY TYPE:
741
ADDRESS:14500 FRUITVALE AVENUETELEPHONE:
(408) 741-7100
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 418CENSUS: 286DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Sarah StelTIME COMPLETED:
03:17 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 07/28/2022 at 01:12pm. LPA met with facility Administrator Sarah Stel (Admin).

LPA toured the facility, including activity room, kitchen, dining room, library, 10 bedrooms, 12 bathrooms, and 2 offices. All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated.

Facility infectious control plan has already been submitted. No prohibited items noted in resident rooms. 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. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. Fire extinguisher observed to be last inspected in September of 2021. All cleaning supplies and chemicals noted to be in locked cabinets and closets. Smoke/carbon monoxide detectors observed. Facility temperature noted to be 73*F.

Facility observed to have designated entry point. Staff took LPAs' temperature and screened for symptoms. 30 days supply of PPE was observed. Hand washing signs were observed in all facility bathrooms. Paper towels were observed in all facility bathrooms. Water temperature observed to be 109.7 *F in facility bathroom. Social distancing signs observed to be posted in all public areas.

No deficiencies cited during today's visit. This report was reviewed with Administrator Sarah Stel and a copy of the signed report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
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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