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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202710
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:12:51 PM


Document Has Been Signed on 09/27/2022 12:12 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:VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THEFACILITY NUMBER:
435202710
ADMINISTRATOR:WILLIAMS, RYANFACILITY TYPE:
740
ADDRESS:20400 SARATOGA LOS GATOS RDTELEPHONE:
(408) 741-2950
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:74CENSUS: DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Travis ClawsonTIME COMPLETED:
12:16 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 09/27/2022. LPA met with Administrator Travis Clawson (Admin).

LPA entered the facility through the designated central point of entry and was screened by staff. Staff, residents in common areas, and visitors were observed to be wearing face coverings. Hand sanitizers, soap, and paper supplies were observed to be available. At least 30 days' supply of personal protective equipment (PPE) was observed to be available in the premises.

LPA toured the with Admin facility. During the tour, LPA observed the temperature to be between 68*F and 78*F in resident bedrooms. Facility water temperature measured at 104.4*F. Fire extinguishers were observed to have been last inspected in February of 2022. Facility was observed to have at least 2 days worth of perishable and one week's supply of nonperishable food. All rooms were observed to be clean and well maintained. All emergency exits observed to be free from obstruction. No prohibited items noted in any resident rooms.

The facility has reached a 100% COVID-19 vaccination rate for residents and staff. Smoke and carbon monoxide detectors were observed and confirmed to be operating properly. The facility's infectious control plan has been submitted and is currently under review by the department.

No deficiencies were cited. Advisory note was issued. Exit interview conducted with Administrator Travis Clawson and a copy of this report was provided during visit.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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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