435202710-3-22-2022-26-AS-KHOS-CD7J2M-20220405064008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:38:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/21/2022 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20220321124447

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:	03/22/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Travis Clawson		TIME COMPLETED:	12:36 PM

ALLEGATION(S):

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Resident sustained severe pressure injuries while in care.
Staff did not seek medical attention for resident in a timely manner.
Staff did not feed resident.
Resident lost a significant amount of weight.
Staff did not ensure resident was taken to doctor's appointments.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced complaint investigation visit today. LPA met with administrator (ADM) Travis Clawson. LPA addressed the purpose of today's visit to ADM, and interviewed ADM. Resident rosters of Assisted Living Unit (AL) and Skilled Nursing Unit (SN) were obtained.

Based on the interviews conducted and records reviewed, alleged resident resided in the skilled nursing unit never in AL, and does not live in the facility now. The Department found the above allegations to be UNFOUNDED meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Exit interview was conducted with ADM. This report was provided to ADM for signature.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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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