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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202710
Report Date: 09/18/2024
Date Signed: 09/18/2024 01:18:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/18/2024 01:18 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:
09/18/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Josephine Almonte - Dir of Staff Development TIME COMPLETED:
01:30 PM
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On 9/18/2024 Licensing Program Analysts (LPAs) Maria (Mita) Partoza and Marcela Yanez, conducted an unannounced Annual Continuation inspection and met with Director of Staff Development (DSD) Josephine Almonte and Facility Registered Nurse (FRN) Analie Limosnero.

At 10:15 a.m. LPAs continued to review the facility record for staff and residents. LPAs reviewed 5 out of 5 resident files. LPAs observed 2 out of 5 resident file needs LIC 602 (Physician's Report) updates and appraisal needs and services plan (LIC 625). DSD and FRN stated they have scheduled a meeting with family and Primary Care Physician (PCP) to update the record. Once updated DSD and FRN stated they will submit completed forms, LIC 625 and LIC 602 to LPA.

At 11:40 a.m. LPAs reviewed 5 out of 5 Staff records and observed 1 out 5 staff records needs updating for education, however, S2 has a valid CNA license. LPAs discussed with DSD and FRN the importance of maintaining and updating staff records. LPAs observed that staff records have current training and current valid certification to provide care and supervision to residents in care.

LPAs requested the following documents for CCLDs record updated, LIC 500, copy surety bond, copy of admission agreement and LIC 308 were provided.

LPAs provided technical assistance for the maintenance/upkeep of residents and staff records.
No deficiencies were cited during todays visit based on California Code of Regulation (CCR) Title 22. An exit interview was conducted with DSD Josephine Almonte and FRN Analie Limosnero. A copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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