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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202710
Report Date: 10/04/2023
Date Signed: 10/04/2023 05:21:38 PM


Document Has Been Signed on 10/04/2023 05:21 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: 31DATE:
10/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Travis ClawsonTIME COMPLETED:
05:25 PM
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Licensing Program Analysts (LPAs) Christine Dolores and Davide Hailu arrived unannounced to conduct the facility's Required - 1 Year. LPAs met with Administrator, Travis Clawson.

During visit, LPAs toured the facility with Administrator to include the entrance, dining room, kitchen, resident bedrooms, bathrooms, offices, medication rooms, and exterior. All fire exit routes are free and clear of obstruction. Fire extinguishers last serviced on 02/10/2023. Hot water temperature maintained at 108 degrees Fahrenheit.

Dining room area is equipped with cups, plates, utensils, and daily menus. Refrigerator temperature maintained at 35 degrees Fahrenheit. Freezer maintained at 0 degrees Fahrenheit. Resident bedrooms supplied with beds, adequate lighting, chair and closet. Bathrooms supplied with toilets, sinks, and showers. Showers equipped with grab bars and shower chairs.

LPAs reviewed 5 resident records. Resident records contained physician's report, TB information, appraisal/needs and services plan, consent forms, identification and emergency information, personal rights, and centrally stored medications records.

LPAs reviewed 5 staff files. Staff records contained 1st aid certification, job applications, health screening, TB information, and criminal record clearance. 3 out of 5 staff contained a 1st aid certification.

Facility has an updated emergency disaster plan. Facility conducts their emergency disaster drills quarterly. Facility is equipped with an emergency disaster kit. First aid kit contains bandages, gauze, tweezers, and scissors.

Due to insufficient time, LPA will return another day for the annual continuation. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Clinical Coordinator, Karen Padilla and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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