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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 04/08/2022
Date Signed: 04/08/2022 10:49:14 AM

Unfounded


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
03/07/2022 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20220307163913
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: 37DATE:
04/08/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Karen PadillaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident was sexually abused
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding regarding the above allegation. LPA met with Karen Padilla, Clinical Coordinator.

On 03/08/2022, LPA opened the 10-day complaint investigation and obtained the following documents to include staff roster and resident roster in assisted living and skilled nursing for the month of February to March 2022. On 03/09/2022, LPA received requested documents via email to include four resident’s physician reports, appraisal needs and services plan, and February staff schedule.

Based on observation, interview and record review, alleged victim resided in the skilled nursing facility and was never a resident in assisted living. Victim does not currently reside at the skilled nursing facility and has moved out of state.

Page 1 of 2.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
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 2
Control Number 26-AS-20220307163913
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 04/08/2022
NARRATIVE
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Alleged perpetrator is a staff at the Skilled Nursing Facility and does not work or cross over to Assisted Living. S1 states the matter was investigated by a few outside agencies in February 2022, to include the California Department of Public Health, Law Enforcement, and the Ombudsman.

The Department has investigated the above allegation. Based on interviews conducted and record reviewed, the Department found the above allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

This report was reviewed with Karen Padilla, Clinical Coordinator and a copy of this report was provided.

Page 2 of 2.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2