Villa-Mar Residential Care Home

Type of visit: Case Management - Other

On May 15, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Other inspection for a facility closure visit, initiated by the Licensee. Upon arrival, the LPA met with family member of the licensee, Mae Sampani. The licensee, Marina Sampani was out of the country. LPA disclosed the purpose of the visit. LPA conducted a walk-through of the facility and inspected all rooms and common areas. The FM stated that they planned to continue caring for one (1) resident (R1) following the facility’s closure, per the request of R1’s family. The FM explained that they would care for R1 as a family friend, as they were very close to R1 and R1’s family. R1 had lived with the licensee for 25 years. R1’s Power of Attorney (POA) did not want R1 to move out of the home, given the long-term residence. R1’s sister also asked the licensee to continue providing care after the facility’s closure. R1 was conserved, and the conservator supported R1’s continued residence in the home. LPA learned that R1’s social worker visited the facility at least once per month but could visit more frequently as there were no restrictions on visit frequency. R1 received care through the Veterans Affairs (VA), and a VA nurse visited the facility every two weeks to monitor medications and conduct body checks. The FM stated they would continue assisting with R1’s medication administration after closure. The FM reported that R1 was independent and able to perform all activities of daily living, including dressing, grooming, bathing, and toileting. R1 continued to attend a day program Monday through Friday and returned home in the evenings. Aside from R1, there were no other residents currently living in the facility. The FM stated that resident and staff records would be retained in storage for three years. Continued on LIC809-C The FM had initiated the facility’s closure and submitted a written request to Community Care Licensing (CCL) to close the facility. The closure inspection of the facility was completed, and the facility was found to be non-operational. Closure was recommended. The facility license was surrendered to LPA by the FM. No deficiencies were cited during today's visit. An exit interview was conducted with the FM. A copy of this report was provided to the FM, Mae Sampani, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, May 15, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christine (Dolores) Kabariti arrived unannounced to conduct a case management – other visit. LPA met with Licensee, Marina Sampani. The purpose of the visit is to follow-up on a facility closure notification the Department received on 01/21/2024. On 08/01/2024, the licensee verbally mentioned plans to close the facility by the end of year 2024. On 01/21/2025, the Department received the facility’s notification regarding their intent to close effective 01/30/2025. Licensee states they did not provide a written notice to R1 as the discussion was all done verbally. Licensee states a plan to provide R1 and R1's power of attorney (POA) with a 60-day written notice following Health and Safety Code Section 1569.682. Upon following up with the licensee, it was found that a resident (R1) has a petition for the licensee to continue providing care and supervision for R1, after the facility closure. This petition is still pending court approval. Licensee states that R1 will continue to remain in the facility until R1’s living situation has been resolved with the court and will follow-up with R1's POA regarding possible relocations. LPA discussed with the Licensee about her succession plan as the licensee is the sole proprietor. The Licensee plans to rescind the forfeiture letter and will submit the new forfeiture letter with the new effective date of closure, reason for closure, and closure plan. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Licensee Marina Sampani and a copy of there report and appeal rights was provided.the state’s words, verbatim · CDSS document, Jan 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.682(a)(2) · Plan of correction due date: Jan 29, 2025

(a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license, as described in subdivision (a), (b), or (f) of Section 1569.19, or a change of use of the facility pursuant to the department’s regulations, take all reasonable steps to transfer affected residents safely and to minimize possible transfer trauma, and shall, at a minimum, do all of the following: (2) Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction. The notice shall include all of the following: This requirement is not met as evidenced by: Based on interview, record review and obervation the licensee did not comply with the section cited as the licensee did not provide resident (R1) and responsible person with a written notice no later than 60 days before the intended closure which poses/posed an immediate health safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 28, 2025

Plan of correction: Licensee states they will rescind the facility's forfeiture letter and resubmit the forfeiture letter with the new closure date. Licensee will serve the resident and resident's responsible person with a 60 day written notice to include all items under Health and Safety Code Section 1569.682. Licensee will send the 60 days written notice that was served to the resident to LPA via email by POC due date of 01/29/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Licensee, Marina Sampani. The purpose of the visit was to follow-up on the written plan of correction from the facility's annual inspection on 05/24/2024. On 06/17/2024, LPA Dolores called the facility's number and Licensee's cell phone number multiple times to follow-up on the plan of correction. LPA did not receive a return call. During visit, the Licensee states they had sent LPA Dolores the plan of correction 3 times via email. LPA Dolores did not receive 3 out of 3 emails. The Licensee's daughter forwarded the emails to LPA Dolores. It was observed the email address that the plan of correction was sent to was incorrect. LPA reviewed the plan of corrections during visit. No further follow-up is needed at this time. No deficiencies are cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Marina Sampani and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 1, 2024

Type of visit: Office

Licensing Program Analyst (LPA) David Marrufo and Licensing Program Manager (LPM) Jackie Jin conducted an Informal Office meeting and met with Licensee Marina Sampani and Mae Sampani. During office visit, LPA and LPM discussed with Licensee Marina Sampani the plans for future facility operations. LPA and LPM advised Licensee Sampani that there needs to be a certified administrator at the facility and informed Licensee about the requirements to become a certified administrator. LPA and LPM discussed that residents need supervision at all times and volunteers cannot be at the facility without staff supervising them. LPA and LPMs discussed that on 05/24/2024 an LPA observed a volunteer sleeping at the facility during a visit in a chair in a vacant resident room. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information. During visit, Licensee Marina Sampani provided a copy of the current LIC500 Personnel Report form. This report was reviewed with Licensee Marina Sampani and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jun 8, 2024

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by: Licensee did not ensure that staff were present at the facility when a Licensing Program Analyst observed there was a volunteer sleeping at the facility and no staff to supervise the residents, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 7, 2024

Plan of correction: Licensee shall submit a Plan of Correction by POC date to ensure that there will be staff at all times in sufficient numbers and competent to provide the services necessary to meet resident needs.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(j) · Plan of correction due date: Jun 8, 2024

(j) Volunteers may be utilized but may not be included in the facility staffing plan. Volunteers shall be supervised. This requirement was not met as evidenced by: Licensee did not ensure that a volunteer was left unsupervised on 05/24/2024 when a Licensing Program Analyst conducted a visit, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 7, 2024

Plan of correction: Licensee shall submit a Plan of Correction by POC date to ensure that volunteers at the facility are supervised by staff when they are at the facility.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required - 1 year inspection. LPA met with Administrator (ADM), Marina Sampani. Upon arrival to the facility, LPA approached the main door and observed a sign stating to enter through the dining room sliding door. LPA was approached by the Administrator's visitor and a staff member. While waiting for the Administrator to arrive, LPA toured the facility with staff (S1) to include the resident bedrooms, bathrooms, living room, dining room, kitchen, staff rooms, and backyard. Fire extinguisher last serviced on 11/07/2022. Administrator contacted the fire inspector who states they will update the fire extinguisher next week. Carbon monoxide detector present. Resident bedroom equipped with beds, lights, linens, night stands and dresser. Bathroom equipped with grab bars, non-slid mats, and hygiene products. Bathroom hot water temperature maintained at 100 degrees Fahrenheit. Administrator states she will contact the facility's maintenance person, ASAP. Facility kitchen equipped with at least 2 days worth of perishables and 7 days worth of non-perishable foods. LPA did not observe a thermometer inside the refrigerator and freezer. Administrator states she will purchase a thermometer for the refrigerator and freezer. Items inside the refrigerator observed covered. Chemicals, disinfectants, and sharp objects observed locked. SEE LIC809-C. LPA reviewed 2 out of 2 resident files. Pages 1 and 2 of resident (R1)'s admission agreement was missing. LPA observed the admission agreement was signed. R1's medical assessment was last updated in 2018. Administrator was advised. R1 and R2's resident's appraisal/needs and services plan was last updated in 2017 and 2018. Administrator was advised. 2 out of 2 residents centrally stored medication records and centrally stored medications were reviewed. LPA reviewed 2 staff files. 2 out of 2 staff CPR and first aid certification expired in 2017. Staff training was last conducted in 2017. Administrator was advised. Staff files contain a health screening, TB result, and fingerprint clearance. LPA advised to update the facility's emergency disaster plan. Administrator demonstrated how they conduct their emergency drills but Administrator states they are not documenting their fire drills at this time. Administrator states she will start documenting their emergency drills again starting tomorrow. Marina's Administrator's Certificate expired in 2020. Administrator verbalized her plan to update her RCFE Administrator Certificate. During visit, LPA was informed of an individual who resides at the facility. Based on review records, the individual is not fingerprint cleared and associated to the facility. Documents were requested to include: LIC500, Liability Insurance, Emergency Disaster Plan, and Infection Control Plan. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 x 5 days) for a person residing in the facility without fingerprint clearance. See LIC421BG. This report was reviewed with Administrator, Marina Sampani and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 24, 2024

Allegation investigated: Facility staff did not assist resident with medical needs

On 4/3/2024, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint inspection. LPA met with Administrator Marina Sampani explained the purpose of the visit. The Department investigated the allegation that staff did not assist resident with medical needs and based on an interview with R1’s provider, there is not a preponderance of evidence to prove or disprove the allegation occurred. The allegation is therefore unsubstantiated. Nothe state’s words, verbatim · CDSS document, Apr 3, 2024 · control 26-AS-20210629163104

Allegation investigated: Facility did not meet resident's needs.

On 4/3/2024, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint inspection. LPA met with Administrator Marina Sampani explained the purpose of the visit. The Department investigated the allegation that facility did not meet resident’s needs and based on interviews with staff from the Day Program, R1 has to come Program on multiple occasions with dried feces in their diaper. Therefore, based on interviews and information collected, the above allegation is determined to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. A copy of this report and the Appeal Rights are provided. Substantiatedthe state’s words, verbatim · CDSS document, Apr 3, 2024 · control 26-AS-20210714143311

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 4, 2024

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met when R1 arrived at Day Program on multiple occasions with dried feces in their diaper.the state’s words, verbatim · CDSS document, Apr 3, 2024

Plan of correction: Licensee has corrected the deficiency.