The Villas at Saratoga Skilled Nursing & Asst Lvg

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced annual inspection visit and met with Administrator Benjamin Roedel. During visit, LPA Marrufo toured the facility inside and out. LPA toured three out of three facility floors. LPA toured the hallway bathrooms on each floor as well as two resident apartment bathrooms on each floor. Each bathroom had working lights and available soap and paper towels. The resident apartment bathrooms had shower chairs and anti-slip floors. The water temperatures in the bathroom sinks measured from 114 F to 119 F. Each observed resident apartment had working lights and available bedding and clothing storage areas. LPA toured the outside areas and found the outdoor exits to be clear of obstructions. LPA toured the kitchen areas on the second and third floors as well as the dining areas. LPA Marrufo reviewed the fire drill log. The last drill was recorded on 08/12/2026. Maintenance Department records indicate the fire alarm system was last inspected on 07/21/2026. LPA reviewed 9 resident Centrally Stored Medication and Destruction Logs and found them to be complete. LPA reviewed 9 resident records. The following resident records were missing: R1's Admission Agreement and Safeguard of Property and Valuables form, R2's Appraisal/Needs and Services Plan, R3's Safeguard of Property and Valuables form, and R4's Admission Agreement. See LIC809-C page for more information. Page 1 of 2. LPA reviewed 7 staff records and found them to be complete. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. LPA Marrufo requests that the following records be updated and copies sent to the department by 09/10/2026: LIC500 Personnel Summary LIC308 Designation of Administrative Responsibility Liability Insurance LIC610 Emergency Disaster Plan This report was reviewed with Administrator Benjamin Roedel and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Sep 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Sep 10, 2026

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Licensee did not ensure that the following resident records were not missing: R1's Admission Agreement and Safeguard of Property and Valuables, R2's Appraisal/Needs and Services Plan, R3's Safeguard of Property and Valuables, and R4's Admission Agreement, which poses a potential safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Licensee agrees to submit copies of R1's Admission Agreement and Safeguard of Property and Valuables, R2's Appraisal/Needs and Services Plan, R3's Safeguard of Property and Valuables, and R4's Admission Agreement by 09/10/2026.

Allegation investigated: Staff mismanaged resident’s medications Staff provided the resident with a broken chair resulting in a fall Staff interfered with the resident’s insurance coverage Staff did not safeguard resident’s personal items Staff did not treat resident with dignity and respect

On 8/12/2026, Licensing Program Analyst (LPA) Yi Sam Jian arrived unannounced for the purpose of conduct complaint investigation and was greeted by Administrator, Benjamin Roedel. Regarding the allegation that staff mismanaged the resident’s medications, the Department conducted an investigation. Due to conflicting statements provided by R1 and insufficient corroborating evidence, the investigation did not establish that the facility mismanaged R1’s medications. Regarding the allegation that staff provided R1 with a broken chair resulting in a fall, the evidence obtained is insufficient to establish that the facility failed to maintain the chair in a safe and good repair condition, resulting in R1’s fall. Regarding the allegation that staff interfered with R1’s insurance coverage, the facility provided information indicating that R1 was a private-pay resident and responsible for her own insurance coverage. There is insufficient evidence to establish that facility staff intentionally or improperly interfered with R1’s insurance coverage. CONT TO 9099C Unsubstantiated Regarding the allegation that staff did not safeguard R1’s personal belongings, R1 provided conflicting statements, and there is a lack of corroborating evidence. There is insufficient evidence identifying a staff member as having taken, misplaced, or otherwise failed to safeguard R1’s belongings. Regarding the allegation that staff did not treat R1 with dignity and respect, R1 and Staffs provided conflicting accounts regarding the statement allegedly made to the paramedics. There is no independent or corroborating evidence to establish that staffs treat R1 without dignity and respect. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove whether the allegations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. No Deficiencies cited under California Code of Regulations Title 22. Report is reviewed and a copy of this report is provided to the administrator.the state’s words, verbatim · CDSS document, Aug 12, 2026 · control 26-AS-20260429082422

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Riley Tucker and Ben Roedel. The purpose of the visit was to respond to an Incident Report (IR) that the facility submitted to the department on 01/08/2026. The IR stated that on 12/31/2025 at around 9:00 AM, staff S1 was assisting resident R1 to the bathroom. S1 briefly left R1 in the bathroom to provide assistance to another resident. Before leaving R1, S1 told R1 to push the emergency call light inside the bathroom once R1 was done using the bathroom. When S1 returned, S1 found R1 sitting on the floor. S1 told S2, a medication technician, about R1's fall. S1 helped R1 back onto R1's wheelchair safely. S2 noted there was no injury to R1. S2 did not report R1's fall to S2's supervisors. During visit, LPA Marrufo obtained copies of R1's Physician's Report and Appraisal/Needs and Services Plan. R1's Physician's Report states R1 is not able to care for R1's own toileting needs. The Background Information section of R1's Appraisal/Needs and Services Plan states, "[R1] requires the help of one person to complete activities of daily living." The Functional Skills section of R1's Appraisal/Needs and Services Plan states, "Resident requires full assistance with all functional mobility and activities of daily living (ADLs), including bathing, dressing, toileting, feeding, and ambulation, due to physical limitations. Dependent on staff for transfers, repositioning, and mobility." See LIC809-C page for more information. Page 1 of 2. During visit, LPA Marrufo obtained a copy of S1's Corrective/Disciplinary Action Form, dated 01/06/2026. The Corrective/Disciplinary Action Form states, "On Dec. 31 around 9am while assisting the resident in the bathroom, caregiver briefly left because [he/she] was not yet finished and checked the resident in front of [redacted]. When the caregiver returned, [he/she] found the resident sitting on the bathroom floor and informed med tech immediately." The form was signed by S1 and S1's supervisor on 01/06/2026. During visit, LPA Marrufo interviewed R1 and S2. R1 stated during interview to have grabbed the grab bar in the bathroom when he/she fell to the bathroom floor. S2 stated during interview that care givers called S2 into R1's apartment. When S2 arrived, R1 had been positioned into R1's wheelchair near R1's bed. S2 stated to have forgotten to notify S2's supervisors about R1's fall. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. An advisory note was issued. See LIC9102 for more information. This report was reviewed with Riley Tucker and Ben Roedel and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Jan 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 10, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Licensee did not ensure that resident R1 received the care, supervision, and services needed to meet R1's toileting needs when staff S1 assisted R1 to the bathroom, which poses an immediate personal rights and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2026

Plan of correction: Licensee agrees to submit a plan of correction by 01/10/2026 stating how the licensee will conduct in-service training with staff to ensure that resident receive the care, supervision, and services that meet their individual needs, including resident's toileting needs. Once training is completed, the licensee shall submit copies of training records, including names of staff trained, dates of training, training topics, and names and qualifications of trainers.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Riley Tucker, Administrator. During visit, LPA Marrufo toured the facility inside and out. LPA toured the hallway bathrooms in the first and second floors. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks were 109 F. LPA observed the first aid kit and found it to be complete. LPA tested the carbon monoxide detector and it functioned properly during testing. During visit, staff tested the smoke detection system and it functioned properly when tested. LPA toured the outside areas and observed the exits to be clear of obstructions. LPA reviewed seven resident Centrally Stored Medication and Destruction Records (CSMDR). Resident R1 was missing two medications in his/her CSMDR. LPA reviewed seven resident records and found them to be complete. LPA reviewed seven staff records. The records of staff S1-S5 were missing the LIC503 Health Screening form. S5 did not have a current first aid certification. The emergency disaster drill log indicates that the last drill occurred on 07/07/2025. See LIC809-C page for more information. Page 1 of 2. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D pages for more information. LPA Marrufo requests that copies of the following documents be updated and sent to the department: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility LIC610E Emergency Disaster Plan This report was reviewed with Administrator Riley Tucker and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Diane De Guzman, Administrator. The purpose of the visit was to follow up on an incident self-reported by the facility to the department via Unusual Injury/Incident Report (IR) on 03/22/2025. The incident occurred on 03/22/2025 and involved resident R1's bottle of medication M1 being reported as missing. The IR states that staff S1 was assisting R1 in the administration of R1's bottle of M1 around 10:00 AM. After completing medication rounds to residents in the facility, S1 left R1's bottle of M1 on top of the medication cart without securing the bottle of M1 inside the locked storage of the medication cart inside the medication room. S1 then proceeded to leave for S1's lunch break and does not recall if S1 locked the door to the medication room. At 2:00 PM, S1 was working with another medication technician to prepare the evening medications when both staff noticed that R1's bottle of M1 had gone missing. After searching the facility, S1 was unable to locate R1's bottle of M1 and notified the facility Administrator and Director of Staff Development. Law enforcement was notified and a police report was made. During visit, LPA Marrufo obtained a copy of the facility medication storage policy, R1's Admission Record, the Controlled Substance Accountability Sheet that was used for R1's bottle of M1 on the day it went missing, and Staff Schedule. See LIC809-C page for more information. Page 1 of 2. During visit, LPA Marrufo interviewed staff S1 and S3. During visit, LPA toured the medication room and observed there to be a surveillance camera installed that was aimed at the medication room door. Administrator De Guzman stated during visit that the camera was installed after the incident occurred. A deficiency was issued as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Diane De Guzman, Administrator, and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT.the state’s words, verbatim · CDSS document, Apr 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Apr 5, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Licensee did not ensure that R1's bottle of medication M1 was kept in a safe and locked place, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 4, 2025

Plan of correction: Licensee agrees to submit a Plan of Correction by POC date stating how the licensee will ensure that resident medications are kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of centrally stored medication.

Allegation investigated: Staff inappropriately touched a resident in care.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced initial complaint investigation visit and met with Josephine Almonte, Director of Staff Development. During visit, LPA Marrufo reviewed the facility resident roster. Based on review of the resident roster, the alleged victim of the allegation is not a resident in Assisted Living and is a resident in the Skilled Nursing portion of the facility. This agency has investigated the complaint allegation listed. Based on review of records, the CCLD has found that the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This report was reviewed with Josephine Almonte and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Jan 9, 2025 · control 26-AS-20250108181141

Type of visit: Case Management - Annual Continuation

On 9/18/2024 Licensing Program Analysts (LPAs) Maria (Mita) Partoza and Marcela Yanez, conducted an unannounced Annual Continuation inspection and met with Director of Staff Development (DSD) Josephine Almonte and Facility Registered Nurse (FRN) Analie Limosnero. At 10:15 a.m. LPAs continued to review the facility record for staff and residents. LPAs reviewed 5 out of 5 resident files. LPAs observed 2 out of 5 resident file needs LIC 602 (Physician's Report) updates and appraisal needs and services plan (LIC 625). DSD and FRN stated they have scheduled a meeting with family and Primary Care Physician (PCP) to update the record. Once updated DSD and FRN stated they will submit completed forms, LIC 625 and LIC 602 to LPA. At 11:40 a.m. LPAs reviewed 5 out of 5 Staff records and observed 1 out 5 staff records needs updating for education, however, S2 has a valid CNA license. LPAs discussed with DSD and FRN the importance of maintaining and updating staff records. LPAs observed that staff records have current training and current valid certification to provide care and supervision to residents in care. LPAs requested the following documents for CCLDs record updated, LIC 500, copy surety bond, copy of admission agreement and LIC 308 were provided. LPAs provided technical assistance for the maintenance/upkeep of residents and staff records. No deficiencies were cited during todays visit based on California Code of Regulation (CCR) Title 22. An exit interview was conducted with DSD Josephine Almonte and FRN Analie Limosnero. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 18, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection visit and met with Director of Staff Development (DSD) Josephine Almonte. LPA stated the purpose of the visit. The facility is licensed to serve adults age 60 years and over; approved for capacity of 74 non-ambulatory, residents, approved hospice waiver for 10 hospice residents. At 2:30 pm LPA observed that residents were in the activity area lobby and most of the residents were participating. LPA toured the facility accompanied by the DSD. including but not limited to the kitchen, bathroom, dining room, living room, 5 of 34 residents rooms, and exterior walkways. The temperature inside the facility is at 74 degrees Fahrenheit. The facility is a 3 floor level building and each level has a medication room that is locked and not accessible to residents, a kitchen/kitchenette and dining room. The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food. The water temperature measured at 113.7 degrees Fahrenheit to 114.2 degrees Fahrenheit. The bathroom/s are equipped with grab bars, and non-skid floors. Resident's room (R1 to R5) have sufficient storage and are kept sanitary and organized. Facility has housekeeping schedule for each floor and cleaning is done everyday for each resident's unit. page 1 of 2, see LIC 809c The ramps and patio are free from debris and obstruction. The facility were observed to be in good repair. The laundry is located on the 2rd level of the facility. The facility offers 2 times a week laundry services for free. The facility is equipped with a fire, smoke and carbon monoxide alert system and is maintained by their maintenance person. The hallway are free from obstruction. The fire extinguisher was inspected on 2/12/2024. LPA reviewed 5 out of 34 resident records such as but not limited to the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening and observed that 5 out of 5 resident needs and services plan are not signed by the resident or the responsible party. 5 out of 5 Physician's Report (LIC 602) are not updated since the admission date. 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 Director of Staff Development Josephine Almonte and a copy of the report was provided. page 2 of 2 end of reportthe state’s words, verbatim · CDSS document, Sep 16, 2024

Allegation investigated: Staff handle resident in care in a rough manner.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation. LPA met with Administrator, Riley Tucker. During the investigation, it was found the allged resident (R1) resides in the skilled nursing facility, not in assisted living. LPA obtained and reviewed the resident roster for assisted living and skilled nursing to confirm. This complaint will be cross-reported to the California Department of Public Health. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unfounded meaning the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Riley Tucker and a copy of the report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Aug 22, 2024 · control 26-AS-20240813090952

Allegation investigated: Staff are not ensuring that the facility phone system is in working order.

On 5/2/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with the Director of Staff Development (DSD), Josephine Almonte & Administrator in Training (AIT), Josh Nabrotzky. LPA explained the purpose of today's visit. Regarding the allegation of staff are not ensuring that the facility phone system is in working order, reporting party (RP) stated that telephone service was not working December 15 through 17, 2022 and then on December. No one is answering the main facility number. LPA interviewed Administrator Travis Clawson and he stated that there wasn’t any disruption of phone services during this time. Aside from the phone numbers posted, the responsible parties know who else to contact if no one is answering the main line. LPA also interviewed AIT and it was mentioned that if there were issues like power outages, the facility uses an application called Clinic Connect where they can send updates straight to family members. DSD also mentioned that contact numbers of staff in the facility are provided to responsible parties upon moving in of a resident. LPA observed postings of phone numbers in bulletin boards and elevators whom family members or responsible parties can contact if the mainline is not available. There were also no incident reported of any outages during this time. Based on interviews, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. Report is reviwed and copy is provided. Unfoundedthe state’s words, verbatim · CDSS document, May 2, 2024 · control 26-AS-20221227113645

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.