435202710-10-4-2023-26-AS-KHOS-CYEQAG-20231211105954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 10/04/2023
Date Signed: 10/04/2023 05:21:56 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
09/27/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230927124631

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:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Travis Clawson		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff left resident in soiled diapers while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Christine Dolores and Davide Hailu arrived unannounced to open the initial complaint investigation. LPAs met with Administrator, Travis Clawson.

On 09/27/2023, the Department recieved the complaint. On 10/04/2023, the initial complaint invesitgation was conducted. During visit, LPA reviewed the resident roster and observed the resident resides in the skilled nursing section of the facility. This complaint will be cross-reported to the California Department of Public Health.

The Department has invesitgated the above allegation. Based on record review and interview, the above allegation is unfounded meaning the allegation is false, could not have happened and/or is without a reasonable basis. This report was reviewed with Clinical Coordinator, Karen Padilla and a copy of the report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

Page: 1 of 3