The Villas at Saratoga Skilled Nursing & Asst Lvg

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility’s annual continuation visit from 10/04/2023. LPA met with Clinical Coordinator (CC), Karen Padilla. The facility has carbon monoxide detectors present throughout the facility. Activities calendar for the month observed posted in the common areas. On 10/04/2023, LPAs observed resident participating in activities such as church service and bingo. On 10/04/2023, LPA entered the kitchen area. The resident's meals are prepared in the facility's skilled nursing section and delivered to assisted living in a food warmer. LPA observed cups of fresh fruits in the assisted living refrigerator which were observed covered. On 10/04/2023, LPAs reviewed 5 resident records. During review of the residents centrally stored medication record (CSMR) it was found resident R2, R4, and R5's CSMRs were missing information. LPA observed R2 was missing 5 medications that were not written in their centrally stored medication record. CC followed-up with the pharmacy who then sent the updated CSMR with the 5 medications. R2's CSMR was missing start dates and refills information. R4's CSMR was missing start dates and refill number information. R5's PRN medication was not written in the CSMR. During today's visit, LPA observed and obtained the facility's in-service training record on medications that was conducted on 10/04/2023. On 10/04/2023, 4 residents and 3 staff were interviewed. The following documents were obtained: updated admission agreement, lease agreement, LLC, liability insurance, LIC-500, LIC-610E, and LIC-308. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Clinical Coordinator, Karen Padilla and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 10, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff left resident in soiled diapers while in care

Licensing Program Analysts (LPAs) Christine Dolores and Davide Hailu arrived unannounced to open the initial complaint investigation. LPAs met with Administrator, Travis Clawson. On 09/27/2023, the Department recieved the complaint. On 10/04/2023, the initial complaint invesitgation was conducted. During visit, LPA reviewed the resident roster and observed the resident resides in the skilled nursing section of the facility. This complaint will be cross-reported to the California Department of Public Health. The Department has invesitgated the above allegation. Based on record review and interview, the above allegation is unfounded meaning the allegation is false, could not have happened and/or is without a reasonable basis. This report was reviewed with Clinical Coordinator, Karen Padilla and a copy of the report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Oct 4, 2023 · control 26-AS-20230927124631

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Christine Dolores and Davide Hailu arrived unannounced to conduct the facility's Required - 1 Year. LPAs met with Administrator, Travis Clawson. During visit, LPAs toured the facility with Administrator to include the entrance, dining room, kitchen, resident bedrooms, bathrooms, offices, medication rooms, and exterior. All fire exit routes are free and clear of obstruction. Fire extinguishers last serviced on 02/10/2023. Hot water temperature maintained at 108 degrees Fahrenheit. Dining room area is equipped with cups, plates, utensils, and daily menus. Refrigerator temperature maintained at 35 degrees Fahrenheit. Freezer maintained at 0 degrees Fahrenheit. Resident bedrooms supplied with beds, adequate lighting, chair and closet. Bathrooms supplied with toilets, sinks, and showers. Showers equipped with grab bars and shower chairs. LPAs reviewed 5 resident records. Resident records contained physician's report, TB information, appraisal/needs and services plan, consent forms, identification and emergency information, personal rights, and centrally stored medications records. LPAs reviewed 5 staff files. Staff records contained 1st aid certification, job applications, health screening, TB information, and criminal record clearance. 3 out of 5 staff contained a 1st aid certification. Facility has an updated emergency disaster plan. Facility conducts their emergency disaster drills quarterly. Facility is equipped with an emergency disaster kit. First aid kit contains bandages, gauze, tweezers, and scissors. Due to insufficient time, LPA will return another day for the annual continuation. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Clinical Coordinator, Karen Padilla and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 4, 2023

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility staff handled resident in a rough manner Residents wounds aren't being treated properly

Licensing Program Analysts Ryker Heberle and Ravi Patel (LPAs) conducted an unannounced complaint investigation regarding the above allegations. LPAs met with facility Administrator Travis Clawson (Admin). During today’s visit, LPAs interviewed 1 staff member (Admin) and reviewed admission documents. Review of assisted living roster did not reflect admission of the alleged victim (R1). Admin confirmed that R1 has never been a resident of the facility’s assisted living wing but is currently a resident of the skilled nursing wing of the facility (SNF). During review of facility's admission records, LPA confirmed that R1 had no admission history in the facility's assisted living wing. Review of R1's admission record indicated that R1 has resided in the SNF wing of the facility for 6 months. Unfounded LPA confirmed that R1 was not and has never been a resident of the facility’s Assisted Living wing. This facility is a Residential Care Facility for the Elderly which contains both an Assisted Living (AL) and Skilled Nursing Facility (SNF). The SNF wing of the facility is not licensed by this department. 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 is without a reasonable basis. No deficiencies were cited during today’s visit. An exit interview was conducted with Travis Clawson, Administrator and a signed copy was provided.the state’s words, verbatim · CDSS document, Apr 18, 2023 · control 26-AS-20230412165806

Type of visit: Required - 1 Year

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 09/27/2022. LPA met with Administrator Travis Clawson (Admin). LPA entered the facility through the designated central point of entry and was screened by staff. Staff, residents in common areas, and visitors were observed to be wearing face coverings. Hand sanitizers, soap, and paper supplies were observed to be available. At least 30 days' supply of personal protective equipment (PPE) was observed to be available in the premises. LPA toured the with Admin facility. During the tour, LPA observed the temperature to be between 68*F and 78*F in resident bedrooms. Facility water temperature measured at 104.4*F. Fire extinguishers were observed to have been last inspected in February of 2022. Facility was observed to have at least 2 days worth of perishable and one week's supply of nonperishable food. All rooms were observed to be clean and well maintained. All emergency exits observed to be free from obstruction. No prohibited items noted in any resident rooms. The facility has reached a 100% COVID-19 vaccination rate for residents and staff. Smoke and carbon monoxide detectors were observed and confirmed to be operating properly. The facility's infectious control plan has been submitted and is currently under review by the department. No deficiencies were cited. Advisory note was issued. Exit interview conducted with Administrator Travis Clawson and a copy of this report was provided during visit.the state’s words, verbatim · CDSS document, Sep 27, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

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

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 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.the state’s words, verbatim · CDSS document, May 24, 2022 · control 26-AS-20220516144743

Allegation investigated: Resident does not have phone service while in care.

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 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.the state’s words, verbatim · CDSS document, May 24, 2022 · control 26-AS-20220517165157

Allegation investigated: Resident was sexually abused

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 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.the state’s words, verbatim · CDSS document, Apr 8, 2022 · control 26-AS-20220307163913

Allegation investigated: Resident sustained severe pressure injuries while in care. Staff did not seek medical attention for resident in a timely manner. Staff did not feed resident. Resident lost a significant amount of weight. Staff did not ensure resident was taken to doctor's appointments.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced complaint investigation visit today. LPA met with administrator (ADM) Travis Clawson. LPA addressed the purpose of today's visit to ADM, and interviewed ADM. Resident rosters of Assisted Living Unit (AL) and Skilled Nursing Unit (SN) were obtained. Based on the interviews conducted and records reviewed, alleged resident resided in the skilled nursing unit never in AL, and does not live in the facility now. 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. Exit interview was conducted with ADM. This report was provided to ADM for signature. Unfoundedthe state’s words, verbatim · CDSS document, Mar 22, 2022 · control 26-AS-20220321124447

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility staff not responding to residents call button. Staff left resident in soiled clothing. Staff left resident in soiled diaper.

Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the findings to the above allegations. LPA met with Travis Clawson Administrator. S1 was interviewed. S1 was not aware of any residents left in soiled clothing or diaper for a long period of time, and staff not responding to residents call button. W1 was interviewed. W1 stated concerns of neglect occurred when R1 was living in the skilled nursing facility. R1 was never a resident in assisted living. SN1 was interviewed. SN1 stated R1 was a resident in the skill nursing facility and R1 was never a resident in assisted living. Resident roster was reviewed and did not indicate R1 as a resident in assisted living. Page 1 of 2 Unfounded 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 is without a reasonable basis. The report was reviewed with Travis Clawson and a copy of this report provided. Page 2 of 2the state’s words, verbatim · CDSS document, Mar 18, 2022 · control 26-AS-20201026105610

Allegation investigated: Staff hit a resident while in care

On 03/17/2022 at 01:44 pm, Licensing Program Analyst (LPA) Ryker Heberle conducted an unannounced initial 10-day complaint investigation regarding the above allegation. LPA met with Travis Clawson, Administrator (Admin). During today’s visit, LPA interviewed 1 staff member (Admin) and requested documents. Admin stated that there have been no residents from Assisted Living that have complained about the allegation listed above. Admin confirmed that the alleged victim (R1) has never been a resident of the facility’s assisted living side but is a resident of the skilled nursing facility (SNF). -Continued, see LIC 9099-C. Unfounded During review of facility's admission records, LPA confirmed that R1 had no admission history in the facility's assisted living wing. LPA further confirmed via admission records that R1 had been residing in the skilled nursing wing of the facility for over 5 years. LPA confirmed that R1 was not and had never been a resident of the facility’s Assisted Living building. Suspected Abuser (SA) was also confirmed to not have worked in the assisted living facility. This facility is a Residential Care Facility for the Elderly which contains both an Assisted Living (AL) and Skilled Nursing Facility (SNF). SNF is regulated by the Department of Public Health. The Department has investigated the above allegation. Based on interviews conducted and documents 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. No deficiencies were cited during today’s visit. Exit interview was conducted with Travis Clawson, Administrator. This report was reviewed with Travis Clawson, Administrator, and a copy was provided.the state’s words, verbatim · CDSS document, Mar 17, 2022 · control 26-AS-20220310160836

Allegation investigated: Unlawful eviction Staff hit resident Staff made inappropriate comments towards resident Facility has mold in showers Staff unlawfully opened residents mail Staff did not safeguard residents personal belongings Staff not meeting resident's needs

On 07/22/2021 at 12:45 pm, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced initial 10-day complaint investigation visit for the above allegations. LPA met with Karen Padilla, Clinical Coordinator. During today’s visit, LPA interviewed 4 staff (S1-S4) and requested documents. 4 out of 4 staff stated there has been no residents from Assisted Living that has complained about the allegations listed above. 4 out of 4 staff confirmed the alleged victim (R1) has never been a resident of the facility’s Assisted Living (AL) side but is a resident of the Skilled Nursing Facility (SNF). S2 stated R1 was discharged from SNF to another acute care hospital. -Continued, see LIC 9099-C. Unfounded A review of the facility’s records confirmed the alleged victim (R1) was not a resident of the facility’s Assisted Living building. This facility is a Residential Care Facility for the Elderly, and this facility has both an Assisted Living (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 allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited during today’s visit. Exit interview was conducted with Karen Padilla, Clinical Coordinator. This report was reviewed with Karen Padilla, Clinical Coordinator, and a copy was provided.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 26-AS-20210714094908

Allegation investigated: Staff did not seek medical attention for resident in a timely manner Staff are not providing adequate food service to resident Staff are not treating residents equally Staff are engaging in inappropriate behaviors with residents Staff dropped resident Staff are not properly quarantining residents

On 07/22/2021 at 12:45 pm, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced initial 10-day complaint investigation visit for the above allegations. LPA met with Karen Padilla, Clinical Coordinator. During today’s visit, LPA interviewed 4 staff (S1-S4) and requested documents. 4 out of 4 staff stated there has been no residents from Assisted Living that has complained about the allegations listed above. 4 out of 4 staff confirmed the alleged victim (R1) has never been a resident of the facility’s Assisted Living (AL) side but is a resident of the Skilled Nursing Facility (SNF). S2 stated R1 was discharged from SNF to another acute care hospital. -Continued, see LIC 9099-C. Unfounded A review of the facility’s records confirmed the alleged victim (R1) was not a resident of the facility’s Assisted Living building. This facility is a Residential Care Facility for the Elderly, and this facility has both an Assisted Living (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 allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited during today’s visit. Exit interview was conducted with Karen Padilla, Clinical Coordinator. This report was reviewed with Karen Padilla, Clinical Coordinator, and a copy was provided.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 26-AS-20210714100229

Allegation investigated: Lack of supervision resulting in resident's engaging in a physical altercation.

On 07/22/2021 at 12:20 pm, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced complaint investigation visit to the deliver the finding to the above allegation. LPA met with Karen Padilla, Clinical Coordinator. On 06/17/2021, an initial 10-day complaint investigation visit was conducted for the above allegation, and the Administrator and 1 staff (S1) was interviewed. The ADM and S1 both stated there has been no residents that had a physical altercation, and any issues were always brought up to staff and taken care of immediately. ADM and S1 stated staff are always available and there has been no issues with lack of supervision. On 06/17/2021, 4 residents were interviewed. 4 out of 4 residents stated staff are always around and available. 4 out of 4 residents stated they have not seen any residents get into a physical altercation with another resident. -Continued, see LIC 9099-C. Unfounded On 07/14/2021, 1 staff (S2) was interviewed. S2 confirmed there is no residents by the alleged victims’ names living on the Assisted Living side. A review of the facility’s records noted no residents by the names reported as the alleged victims. The Department has investigated the above allegation. Based on interviews conducted and document review, 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. No deficiencies were cited during today’s visit. Exit interview was conducted with Karen Padilla, Clinical Coordinator. This report was reviewed with Karen Padilla, Clinical Coordinator, and a copy was provided.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 26-AS-20210610164056

Type of visit: Required - 1 Year

On 07/22/2021 at 11:33 am, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced Annual Required 1 Year visit. LPA met with Karen Padilla, Clinical Coordinator. LPA toured the facility beginning with the main entrance. The entrance had a thermometer, hand sanitizer, and sign-in log to document temperature and screening questions. Universal precautions, COVID-19 protocols, and social distancing guidelines were posted throughout the facility. Restrooms had hand soap and paper towels readily available. Hand washing sign was posted at all hand washing stations. Staff and residents were observed wearing a mask and following COVID-19 protocols. Facility observed to have adequate supply of PPE. No deficiencies were cited during today's visit. This report was reviewed with Karen Padilla, Clinical Coordinator, and a copy was provided.the state’s words, verbatim · CDSS document, Jul 22, 2021