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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202938
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:53:56 PM

Document Has Been Signed on 09/16/2024 02:53 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, JUSTINFACILITY TYPE:
740
ADDRESS:18846 CASA BLANCATELEPHONE:
(408) 914-1147
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 6CENSUS: 0DATE:
09/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Applicants, Justin Ladwig and Irish LadwigTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Simi Rai arrived announced to conduct a follow up visit from the pre-licensing inspection conducted on 8/29/2024. LPA Rai met with Applicants Justin Ladwig and Irish Ladwig and stated the purpose of today's visit.

The facility has an approved fire clearance for 6 non-ambulatory residents.

LPA Rai followed up on issues which were observed on visit 8/29/2024. LPA Rai observed the updated sketch and all areas were updated, including the kitchen area, laundry room, bathroom #3 and exit #3. At this time, all 6 out of 6 resident bedrooms are non-ambulatory.

No issues noted during this pre-licensing inspection.
COMP III was reviewed during visit.
LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

This report was reviewed with Applicants Justin Ladwig and Irish Ladwig. A copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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