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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201057
Report Date: 11/15/2024
Date Signed: 11/15/2024 01:31:48 PM

Document Has Been Signed on 11/15/2024 01:31 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/
DIRECTOR:		SARAH STELFACILITY TYPE:
741
ADDRESS:14500 FRUITVALE AVENUETELEPHONE:
(408) 741-7100
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 418CENSUS: 88DATE:
11/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:Rubina BanwaitTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 10/28/24, Licensing Program Analyst (LPA) Grace Donato conducted an an unannounced case management visit to deliver a copy of amended report from 10/28/24. LPA met with Clinical Services Supervisor, Rubina Banwait and explained the purpose of the visit.

An amended report was delivered in reference to complaint # 26-AS-20220110162643.

Report is reviewed and copy is provided.
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
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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