435202710-7-23-2021-26-AS-SYIP-C5LU8C-20210805152118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 07/22/2021
Date Signed: 07/23/2021 04:15:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/10/2021 and conducted by Evaluator Anna Bui

COMPLAINT CONTROL NUMBER: 26-AS-20210610164056

FACILITY NAME:	VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE		FACILITY NUMBER:	435202710
ADMINISTRATOR:	WILLIAMS, RYAN		FACILITY TYPE:	740
ADDRESS:	20388 SARATOGA LOS GATOS RD		TELEPHONE:	(408) 741-2950
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	74	CENSUS: 32	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Karen Padilla		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Lack of supervision resulting in resident's engaging in a physical altercation.

INVESTIGATION FINDINGS:

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On 07/22/2021 at 12:20 pm, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced complaint investigation visit to the deliver the finding to the above allegation. LPA met with Karen Padilla, Clinical Coordinator.

On 06/17/2021, an initial 10-day complaint investigation visit was conducted for the above allegation, and the Administrator and 1 staff (S1) was interviewed. The ADM and S1 both stated there has been no residents that had a physical altercation, and any issues were always brought up to staff and taken care of immediately. ADM and S1 stated staff are always available and there has been no issues with lack of supervision.

On 06/17/2021, 4 residents were interviewed. 4 out of 4 residents stated staff are always around and available. 4 out of 4 residents stated they have not seen any residents get into a physical altercation with another resident.
-Continued, see LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Anna Bui	TELEPHONE: 650-269-7419
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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-20210610164056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE	FACILITY NUMBER: 435202710
	VISIT DATE: 07/22/2021

NARRATIVE

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On 07/14/2021, 1 staff (S2) was interviewed. S2 confirmed there is no residents by the alleged victims’ names living on the Assisted Living side.

A review of the facility’s records noted no residents by the names reported as the alleged victims.

The Department has investigated the above allegation. Based on interviews conducted and document review, the Department found the above allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies were cited during today’s visit.

Exit interview was conducted with Karen Padilla, Clinical Coordinator. This report was reviewed with Karen Padilla, Clinical Coordinator, and a copy was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Anna Bui	TELEPHONE: 650-269-7419
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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