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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202710
Report Date: 09/03/2026
Date Signed: 09/03/2026 04:27:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/03/2026 04:27 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:VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THEFACILITY NUMBER:
435202710
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, RYANFACILITY TYPE:
740
ADDRESS:20388 SARATOGA LOS GATOS RDTELEPHONE:
(408) 741-2950
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 74CENSUS: 45DATE:
09/03/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Benjamin RoedelTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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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.
Christine Kabariti
David Marrufo
DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2026
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 4
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: VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE
FACILITY NUMBER: 435202710
VISIT DATE: 09/03/2026
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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 REPORT
NAME OF LICENSING PROGRAM MANAGER: Christine Kabariti
NAME OF LICENSING PROGRAM ANALYST: David Marrufo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/03/2026 04:27 PM - It Cannot Be Edited


Created By: David Marrufo On 09/03/2026 at 03:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE
FACILITY NUMBER: 435202710

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2026
Section Cited
CCR
87506(a)

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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.
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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.
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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.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christine Kabariti
NAME OF LICENSING PROGRAM MANAGER:
David Marrufo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2026


LIC809 (FAS) - (06/04)
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