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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202938
Report Date: 08/29/2024
Date Signed: 08/29/2024 04:41:43 PM

Document Has Been Signed on 08/29/2024 04:41 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:SARATOGA SENIOR LIVINGFACILITY NUMBER:
435202938
ADMINISTRATOR/
DIRECTOR:		LADWIG, IRISHFACILITY TYPE:
740
ADDRESS:18846 CASA BLANCATELEPHONE:
(408) 914-1147
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 6CENSUS: 0DATE:
08/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Applicants, Justin Ladwig and Irish LadwigTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez arrived announced to conduct the pre-licensing inspection. LPAs met with Applicants Justin Ladwig and Irish Ladwig

The facility has an approved fire clearance for 5 non-ambulatory residents and 1 bedridden resident.

During visit, LPAs toured the interior to include 6 resident bedrooms, 1 staff bedroom, 3 bathrooms (1 bathroom located in Staff bedroom), living room, dining room, kitchen, backyard, and front yard. All fire exit routes are free and clear of obstruction. Fire extinguisher, carbon monoxide detector was tested, and complete first aid kit observed present.

Interior temperature maintained between 72 degrees Fahrenheit. Sufficient cups, plates, bowls, and utensils observed. Refrigerator temperature maintained at 43.9 degrees Fahrenheit. Bedrooms equipped with beds, linens, adequate lighting, chair, night-stand, and closet.

Hot water temperature in the bathrooms ranged from 110.5 - 112.3 degrees Fahrenheit. Hot water temperature in the kitchen sink maintained at 110.1 degrees Fahrenheit. Bathroom shower does contain a non-slip mat and grab bars. Laundry room contains Laundry appliances and supplies will be in locked cabinet. Facility has an area to lock medications and records. Posters observed to include the licensing complaint poster, personal rights and rights of resident council.

LPAs observed COVID-19 PPE supplies and emergency supplies, including flashlights. LPAs observed door alarm on exit doors.

Continuation on LIC 809-C, Page 1 of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: SARATOGA SENIOR LIVING
FACILITY NUMBER: 435202938
VISIT DATE: 08/29/2024
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There were issues observed during today's visit. Based on facility sketch submitted, LPAs observed two areas noted on the sketch which were not present at the facility. One bathroom located between living room and staff room does not exist and dining/kitchen room was located at a different location on the sketch. LPAs observed one exit door located in between bedroom #4 & #5 which was not on facility sketch. Based on fire clearance approved, bedroom #1 and #2 are approved for non-ambulatory or bedridden. Applicants confirmed bedroom #6 is bedridden which is not specified on approved fire clearance.

Applicants will submit an updated facility sketch with the appropriate changes which reflect the existing floor plan. Applicants stated they will reach out to Santa Clara County Fire Department to obtain clarification on approved fire clearance.

Pre-Licensing is incomplete with issues to be resolved. A follow up Pre-licensure LIC809 will be generated upon resolution of issues.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2