435202710-9-16-2024-26-AS-MPAA-D972JE-20240916172614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202710
Report Date: 09/16/2024
Date Signed: 09/16/2024 05:26:32 PM

Document Has Been Signed on 09/16/2024 05:26 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, 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: 31	DATE:	09/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:			TIME COMPLETED:	05:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection visit and met with Director of Staff Development (DSD) Josephine Almonte. LPA stated the purpose of the visit. The facility is licensed to serve adults age 60 years and over; approved for capacity of 74 non-ambulatory, residents, approved hospice waiver for 10 hospice residents. At 2:30 pm LPA observed that residents were in the activity area lobby and most of the residents were participating. LPA toured the facility accompanied by the DSD. including but not limited to the kitchen, bathroom, dining room, living room, 5 of 34 residents rooms, and exterior walkways. The temperature inside the facility is at 74 degrees Fahrenheit. The facility is a 3 floor level building and each level has a medication room that is locked and not accessible to residents, a kitchen/kitchenette and dining room. The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. The water temperature measured at 113.7 degrees Fahrenheit to 114.2 degrees Fahrenheit. The bathroom/s are equipped with grab bars, and non-skid floors. Resident's room (R1 to R5) have sufficient storage and are kept sanitary and organized. Facility has housekeeping schedule for each floor and cleaning is done everyday for each resident's unit. page 1 of 2, see LIC 809c

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/16/2024

NARRATIVE

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The ramps and patio are free from debris and obstruction. The facility were observed to be in good repair. The laundry is located on the 2rd level of the facility. The facility offers 2 times a week laundry services for free.

The facility is equipped with a fire, smoke and carbon monoxide alert system and is maintained by their maintenance person. The hallway are free from obstruction. The fire extinguisher was inspected on 2/12/2024.

LPA reviewed 5 out of 34 resident records such as but not limited to the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening and observed that 5 out of 5 resident needs and services plan are not signed by the resident or the responsible party. 5 out of 5 Physician's Report (LIC 602) are not updated since the admission date.

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 Director of Staff Development Josephine Almonte and a copy of the report was provided.

page 2 of 2
end of report

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2