435202710-4-18-2023-26-AS-KHOS-CRLMN7-20230507094505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 04/18/2023
Date Signed: 04/18/2023 02:38:43 PM

Unfounded

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
04/12/2023 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20230412165806

FACILITY NAME:	VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE		FACILITY NUMBER:	435202710
ADMINISTRATOR:	WILLIAMS, RYAN		FACILITY TYPE:	740
ADDRESS:	20400 SARATOGA LOS GATOS RD		TELEPHONE:	(408) 741-2950
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	74	CENSUS: 29	DATE:	04/18/2023
		UNANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Travis Clawson		TIME COMPLETED:	02:41 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner
Residents wounds aren't being treated properly

INVESTIGATION FINDINGS:

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Licensing Program Analysts Ryker Heberle and Ravi Patel (LPAs) conducted an unannounced complaint investigation regarding the above allegations. LPAs met with facility Administrator Travis Clawson (Admin).

During today’s visit, LPAs interviewed 1 staff member (Admin) and reviewed admission documents. Review of assisted living roster did not reflect admission of the alleged victim (R1). Admin confirmed that R1 has never been a resident of the facility’s assisted living wing but is currently a resident of the skilled nursing wing of the facility (SNF).

During review of facility's admission records, LPA confirmed that R1 had no admission history in the facility's assisted living wing. Review of R1's admission record indicated that R1 has resided in the SNF wing of the facility for 6 months.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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-20230412165806

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: VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE	FACILITY NUMBER: 435202710
	VISIT DATE: 04/18/2023

NARRATIVE

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LPA confirmed that R1 was not and has never been a resident of the facility’s Assisted Living wing.

This facility is a Residential Care Facility for the Elderly which contains both an Assisted Living (AL) and Skilled Nursing Facility (SNF). The SNF wing of the facility is not licensed by this department. SNF is regulated by the Department of Public Health.

The Department has investigated the above allegations. Based on interviews conducted and documents reviewed, the Department found the above allegations to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

No deficiencies were cited during today’s visit. An exit interview was conducted with Travis Clawson, Administrator and a signed copy was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC9099 (FAS) - (06/04)

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