435202710-5-24-2022-26-AS-KHOS-CGJHZP-20220721063840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 05/24/2022
Date Signed: 05/24/2022 12:41:32 PM

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
05/16/2022 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20220516144743

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's room heater is in disrepair
Staff are not providing a safe environment for resident

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 allegations. LPAs met with facility administrator Travis Clawson (Admin).

During the inspection, LPAs interviewed 4 residents and 3 staff members, and reviewed facility files, including resident roster and 2 resident progress notes. In interview with Admin, Admin stated that there were currently no residents within the assisted living side of the building that have complained about the allegations listed above. In review of resident progress notes, it was indicated that the alleged victim (R1) had recently been transferred from the assisted living side of the facility to the skilled nursing side of the facility in response to a recent hospitalization. Instances of the above allegations were said to have occurred after R1's transfer to skilled nursing.

Continued in 9099-C

Unfounded

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-20220516144743

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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LPAs toured the facility and interviewed 4 residents in their rooms. 2 out of 4 residents interviewed stated that the climate controls in their rooms function properly. 1 out of 4 residents stated that the climate controls break often, but that the facility staff always fixes them. 1 out of 4 residents stated that they did not feel like they knew enough to make a determination. 3 out of 4 residents interviewed stated that they believed the facility was providing a safe environment to live in, while 1 out of 4 stated that they did not feel like they knew enough to make a determination.

This facility is a Residential Care Facility for the Elderly which contains both an Assisted Living Facility (AL) and Skilled Nursing Facility (SNF). SNF is regulated by the Department of Public Health.

The Department has investigated the above allegations. Based on interviews conducted and documents reviewed, 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.

No deficiencies were cited during today’s visit.

Exit interview was conducted with Travis Clawson, Administrator and a copy of the signed 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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