435202710-5-24-2022-26-AS-KHOS-CGJJ5X-20220721064529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 05/24/2022
Date Signed: 05/24/2022 12:43:00 PM

Unsubstantiated

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
05/17/2022 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20220517165157

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: 34	DATE:	05/24/2022
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Travis Clawson		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident does not have phone service while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts Ryker Heberle and Mandeep Kaur (LPAs) conducted an unannounced visit to open an investigation regarding the above allegation. LPAs met with facility administrator Travis Clawson (Admin).

During the inspection, LPAs interviewed 4 residents and 3 staff members (including Admin), and reviewed facility files, including resident roster and 2 resident progress notes. During interviews with Admin, Admin stated that the facility had recently been implementing a new phone system. The facility's IT team purchased and installed all of the new phones in the facility, the facility did not enlist the assistance of outside vendors. Admin stated that during the process of setting up the new phone system, some of the old phones at the facility ceased to function properly.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

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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Control Number 26-AS-20220517165157

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: 05/24/2022

NARRATIVE

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Admin stated that the new phones were installed one at a time inside resident rooms, and that when old phones ceased to function, they were replaced within a couple days. Admin stated that all CNA's on the facility floor had work phones that residents are allowed to borrow as needed, and that residents have alternate means of telecommunication in the event of personal phone outages. LPAs observed resident phones to currently be functioning properly.

LPAs interviewed 4 residents at the facility. 2 out of 4 residents interviewed stated that they have never had issues with their phones. 1 out of 4 residents stated that they have their own cell phone, so they never need to use the facility provided phones. 1 out of 4 residents stated that they did not feel comfortable making a determination.

In interviews with facility staff members, 2 out of 2 staff members stated that they always have a work phone when working CNA duties, 2 out of 2 staff stated that they allow residents to use their phones when requested. 2 out of 2 staff stated that in the event of residents not having phones that work, they can push their signals to summon staff to use their phones.

The Department has investigated the above allegation. Based on interviews conducted, records reviewed, and LPAs' observations, the Department found the above allegation to be UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur.

Exit interview conducted with Administrator Travis Clawson and a copy of this report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

LIC9099 (FAS) - (06/04)

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