Saratoga Senior Living

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Jeanette Mongeon, Administrator. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed there to be locked cabinets and drawers for cleaning supplies and sharp objects. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete. LPA tested the smoke and carbon monoxide detector system and found it to function properly when tested. LPA toured six out of six resident bedrooms and found them to have working lights and available bedding and clothing storage areas. LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured from 117 F to 119 F. LPA toured the outside area and observed the outdoor exits were clear of obstructions. LPA reviewed the resident records, including the Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed four staff records and found them to be complete. See LIC809-C page for more information. Page 1 of 2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The Emergency Disaster Drill Log indicates that the last drill was conducted on 08/26/2025. During visit, LPA Marrufo obtained copies of the following documents: Certificate of Liability Insurance LIC308 Designation of Facility Responsibility LIC500 Personnel Report No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Jeanette Mongeon and a copy of this report was provided.

During interview on 05/15/2025, resident R1 stated that R1’s last fall occurred in R1’s bedroom. R1 stated that during the fall, the staff were in the bedrooms of other residents or in the common area. R1 stated the staff provide R1 with enough supervision. R1 stated staff are always with R1 and walk R1 to the eating area and restroom, including while R1 showers. During visit on 07/22/2025, LPA Marrufo interviewed staff S1-S4. During interviews, S1 and S3 stated that R1 experienced a fall in April 2025. S1 and S3 stated that R1 was sitting in the living room while S1 and S3 were in the bedroom of a resident who required cleaning and changing assistance of two staff. S1 and S3 stated R1 had an alarm attached to R1’s walker and S1 and S3 regularly reminded R1 to use the alarm if R1 needs assistance with standing or ambulating. S3 stated R1’s walker has a sign reminding R1 to use the alarm for assistance. S1 and S3 stated R1 stood up without using the alarm and S1 witnessed R1 fall. S1 was able to immediately assist R1 after the fall. During visit on 07/22/2025, LPA Marrufo observed a sign on a food tray in the living room near a chair. The food tray had a sign taped to it that said, “Call for Help! Before getting up.” LPA Marrufo observed R1’s walker. LPA Marrufo observed that R1’s walker also has a sign attached to it that says, “Call for Help! Before getting up.” LPA Marrufo observed R1’s bedroom has a sign that says “Call don’t fall” and has a photograph of an alarm button. During interview on 05/15/2025, R1 stated to have an alarm installed on R1’s bedroom floor. R1 stated to also have an emergency pendant, which LPA Marrufo observed during interview. R1 stated staff respond to the pendant alarm within two minutes, including when R1 pushes the pendant alarm at night. During interviews on 07/22/2025, S1-S4 stated that they respond within a minute to R1’s emergency pendant alarm. Page 2 of 3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During visit on 07/22/2025, LPA Marrufo obtained a copy of R1’s Morning Diaper Change Log for April and May 2025. The Morning Diaper Change Logs record staff assisting R1 with diaper changes at least once per day in April and May 2025, with some days indicating staff changed R1’s diapers up to four times in a day. During interview on 05/15/2025, R1 stated staff change R1’s diapers as often as R1 wants. R1 stated staff have never left R1 in soiled diapers for an extended period. During interviews on 07/22/2025, S1 and S3 stated staff change R1’s diapers at least every two hours. S2 and S4 stated they change R1’s diapers three times at night. During visit on 07/22/2025, LPA Marrufo obtained a copy of R1’s Shower/Bath Log from April and May 2025. R1’s Shower/Bath Logs indicate that in April 2025, R1 received 4 showers and 26 sponge baths and in May 2025, R1 received 9 showers and 21 sponge baths. During interview on 05/15/2025, R1 stated staff provide showers to R1 once every other day. R1 stated staff sometimes provide R1 with a sponge bath. R1 stated staff recently gave R1 a sponge bath because R1 was not able to take a shower. During interviews on 07/22/2025, S1 and S3 stated staff give R1 showers 3 times a week and sponge baths 4 times a week. S2 and S4 stated staff shower R1 every other day. Based on information from interviews conducted with staff and residents, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Justin and Irish Ladwig and a copy of this report was provided. Page 3 of 3. END REPORT.

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.

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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 2 of 2. 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.