Villa Marin Ambulatory Care Unit

Allegation investigated: Staff do not ensure the needs of the residents in care are met

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with front desk receptionists. Administrator, Karina Tapia, arrived during visit at approximately 9:45AM. LPA also met with CEO, Nicole Mashburn. The Department investigated the allegation that staff do not ensure the needs of the residents in care are met. The complaint was submitted on behalf of multiple residents and alleged that the Provider failed to meet residents’ needs by refusing to send Health Center nurses to residents residing in the Independent Living (IL) condominium units. During the investigation, the Department interviewed management and reviewed resident contracts, Villa Marin’s Certificate of Authority (COA), and other related documentation. Document review determined that the IL condominium units are not licensed as a Residential Care Facility for the Elderly (RCFE) and are intended for independent living. The COA and resident contracts further Continued on LIC9099C Unfounded Continued from LIC9099 establish that Provider staff are not authorized to provide supervision, personal care, or skilled nursing services within the IL condominium units. Services requiring a licensed level of care must instead be provided in an appropriately licensed setting, including the Assisted Living or Skilled Nursing/Health Care Center. Management reported that residents living in the IL condominium units continue to receive services consistent with independent living, including housekeeping, maintenance, meals, and security. Residents also have access to an ambulatory/outpatient clinic where they may receive routine medical services, including blood work, physician visits, pre-assessment and pre-admission evaluations, and other routine or minor medical care. However, nursing, medication assistance, personal care, supervision, and other RCFE-type services are not provided by Provider staff inside the IL condominium units. Residents requiring nursing services are directed to receive those services through the clinic or another appropriate licensed setting. During the investigation, management acknowledged that under a prior administration, Health Center nurses had entered IL condominium units to provide minor first aid and respond to medical emergencies. Management stated that residents had also previously been instructed to contact nursing staff rather than call 911 in the event of an emergency. Current management reported becoming aware of this practice approximately six months ago and discontinuing it after determining that nursing services should not be provided by staff within the IL condominium units. Management further reported that the change resulted in resistance from some residents. Current management has since instructed IL residents to call 911 when experiencing a medical emergency. When a 911 call is placed from an IL condominium, the front desk is alerted and on-site security responds to the unit and remains with the resident until emergency medical services arrive. Security may provide general support and address immediate environmental safety concerns but does not provide nursing or medical care. Management also reported that residents have been informed of the limitations on services available within the IL condominiums through emails, weekly written communications, resident transparency meetings, and communications involving the Board of Directors. When a resident's needs increase beyond what can appropriately addressed while residing independently, residents may be referred to their primary care physician, hospital or emergency services as appropriate, social services, or other available resources. Residents may also discuss transitioning to a higher level of care, such as Assisted Living, or obtaining private care assistance when appropriate. Continued on LIC9099C Continued from LIC9099C Although nursing services were reportedly provided within the IL condominium units under prior management, the evidence reviewed does not establish that current management's decision to discontinue that practice constitutes a failure to meet residents' needs. Rather, the evidence indicates that current management discontinued the practice because the IL condominium units are not licensed for the provision of RCFE-level care and Provider staff are not authorized under the applicable COA and resident contracts to provide supervision, personal care, or skilled nursing services within those units. Residents continue to have access to appropriate medical, emergency, and higher-level care services through the clinic, emergency medical services, and the Provider's licensed care settings. Based on interviews conducted and documents reviewed, the allegation that staff do not ensure the needs of the residents in care are met is determined to be Unfounded. An allegation that is Unfounded means that the allegation was false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of report discussed and provided to CEO. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 12, 2026 · control 21-AS-20260713183522

Type of visit: Case Management - Annual Continuation

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year Visit and met with the front desk receptionists. Administrator, Karina Tapia, arrived during visit at approximately 9:45AM. Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 16 residents in care in Assisted Living and 3 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. LPA reviewed resident files and resident medication. Resident files were found to be well organized and thorough. Files had updated assessments and appraisals. LPA discussed with Administrator on ensuring that resident appraisals address behavioral expressions if they have been identified in resident medical assessments. Medication was observed to be centrally stored and secure. LPA discussed the following with Administrator: Reporting Requirements PIN regarding 911 protocols PIN regarding dementia regulations Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Personnel Report (LIC 500) Liability Insurance Documents to be submitted to Community Care Licensing (CCL) by due date of 09/12/2026. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 12, 2026

Type of visit: Required - 1 Year

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year Visit and met with Director of Nursing, Bridget Geist, and Director of Staff Development, Justin Salter. Administrator, Karina Tapia, was unavailable during visit. Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 17 residents in care in Assisted Living and 3 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Director of Staff Development and observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for a sample size of 4 sinks were found to be out of compliance with Title 22 regulations of 105 to 120 degrees Fahrenheit, measuring at 121.8F, 121.2F, 124.8F, and 123.0F. Facility was observed to have emergency evacuation chairs at their stairwells. Facility fire extinguishers were last inspected June 2026. Smoke and carbon monoxide detectors are hardwired and were last inspected July 2026. Facility's sprinkler and fire system were last inspected February and May 2026. Facility's last emergency/disaster drill was conducted July 2026. Facility was observed to have an adequate supply of emergency water accessible in the event they needed to shelter in place for 72 hours. Continued on LIC809C Continued from LIC809 LPA reviewed staff files. Staff files were all found to be well organized and thorough. Files were observed to have current First Aid and CPR certification and annual training. Administrator's Certificate for Karina Tapia (7029240740) was current with an expiration of 11/20/2026. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date to finish file review and medication audit. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, Plan of Corrections, Appeal Rights discussed and provided to Director of Nursing. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 23, 2026

Type of visit: Case Management - Other

On 06/24/2026, Program Analyst (PA) Lovina Aquino and Financial Analyst (FA) George Rizk arrived at the facility and met with Executive Director (ED) Nicole Mashburn and Health Services Administrator (HSA) Karina Tapia to complete the required triennial visit for Villa Marin, a Continuing Care Retirement Community (CCRC). Prior to the visit, the PA and FA reviewed documentation requested from and provided by the HSA to ensure that the provider is operating the CCRC in compliance with the statutes and is performing the services specified in its continuing care contracts. During today’s visit, the PA, FA, ED and HSA discussed the documentation received prior to the visit and toured the CCRC to ensure that all required postings and documents were accessible to residents and visitors. This includes the Certificate of Authority, which remains valid and is properly displayed at the front desk. CCCB staff also toured the community, observing the assisted living, independent living and skilled nursing unit. During the tour, CCCB staff verified that the required postings and meetings, as outlined in H&SC 1771.7 and 1771.8, are in place and compliant. As a result of today’s visit, no compliance issues pursuant to the Continuing Care Contract Statutes were cited. CCCB staff will follow up with a thank you letter, and summary provided to the ED within 7 days of the visit. An exit interview was conducted with the ED and HSA. Due to connectivity issues, CCCB staff completed the LIC 809 upon return to HQ and emailed the ED for signature.the state’s words, verbatim · CDSS document, Jun 24, 2026

Type of visit: Case Management - Other

On April 16, 2026, a meet and greet was conducted at Villa Marin, a continuing care retirement community, to provide an opportunity for introductions and general discussion. The meeting included Alycia Rayner, Assistant Branch Chief, and Jennifer Houston, CCCB Manager. Nicole Mashburn, Executive Director, and Ben Levesque, CFO were present. A tour of the facility was also conducted. The purpose of this meet and greet was solely to establish communication and rapport. The meeting was not conducted for compliance or regulatory review purposes, and no issues were identified during the visit. No further action is necessary. This form was emailed following the visit due to connectivity issues and was subsequently signed by the Executive Director.the state’s words, verbatim · CDSS document, Apr 16, 2026

Type of visit: Case Management - Annual Continuation

At approximately 9:25AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year Visit and met with Administrator, Paul Durancyzk. Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 14 residents in care and 3 staff members on-site. LPA conducted a walk-through of the facility and made the following observations: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has an Infection Control Plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for Resident use. Hot water temperatures for a sample size of 4 sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. LPA reviewed staff training, resident files, and resident medications. Staff were found to have training as required. Resident files were found to be well organized, thorough and contained the required documentation. During medication review for 2 residents, LPA observed documentation discrepancies on the centrally stored medication log. LPA observed that some medications did not log the correct start date, expiration date, or quantity of medication received. LPA and Administrator, and Director of Nursing discussed reviewing centrally stored medication log and documentation expectations (deficiency cited, LIC809D, regulation 87465(h)(6)) Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Updated Liability Insurance Active and Current Administrator Certificate Facility Documents to be submitted to Community Care Licensing (CCL) by due date of 08/15/2025. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Required - 1 Year

At approximately 12:25PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year Visit and met with Administrator, Paul Durancyzk. Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 13 residents in care and 3 staff members on-site. At approximately 12:50PM, LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. LPA reviewed staff files. Staff files were all found to be well organized, thorough and contained the required documentation. Files were all found to have current First Aid and CPR certification. Administrator's Certificate for Paul Durancyzk was current with an expiration date of 10/26/2025. Facility's fire extinguishers and facility hardwired smoke/carbon detectors were last inspected June 2025. Facility's sprinkler system were last inspected May 2025. Facility's last emergency/disaster drill was conducted June 2025. LPA unable to complete the Annual Inspection. Annual Continuation Visit to be conducted at a later date to complete review of staff training, resident files, and resident medication. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 1, 2025

Allegation investigated: Staff did not allow resident to continue scheduled provider/resident meeting Staff did not allow resident to record during resident's meetings

On 02/26/2025, Licensing Program Analyst (LPA) Felias arrived at facility unannounced to deliver findings related to the above listed allegations. LPA met with Health Services Administrator, Paul Duranczyk, and CEO, Nicole Mashburn, and explained the purpose of today’s visit. The California Department of Social Services (the Department) received a complaint related to the rights of Continuing Care Retirement Community (CCRC) residents to meet with staff and record meetings between an individual resident and staff. During the course of this investigation the Department reviewed records including but not limited to the Villa Marin Residency Agreement for Resident 1 (R1), community resident rosters, community staff rosters and email communications. The Department also conducted interviews with community residents and community staff. A physical inspection of the facility site was also conducted. Continued on LIC9099C Unfounded Continued from LIC9099 Allegation 1: Staff did not allow resident to continue scheduled provider/resident meeting. Based on the documentation reviewed and interviews conducted, staff 1 (S1) met with R1 on December 12, 2024 to discuss information related to R1’s Residential Living Unit (RLU). R1 attempted to record the meeting and S1 declined to give consent for the recording. R1 continued to record and as a result, S1 was unwilling to further participate in the discussion. There is no evidence to suggest that R1 was denied the opportunity to engage in this discussion had it not been recorded therefore the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation 2: Staff did not allow resident to record during resident's meetings. Based on the documentation reviewed and interviews conducted, R1 and S1 were meeting on December 12, 2024 to discuss information related to R1’s Residential Living Unit (RLU). The meeting was being held on a voluntary basis by both parties. There is consensus between R1 and S1 that S1 was unwilling to participate in the intended discussion while being recorded. Under California law all parties must consent to the recording of a confidential communication. Based on the investigation conducted, there is no evidence to support that this meeting was held for the purpose of discussing public matters or for the benefit of the residents in the community as a whole. No community residents other than R1 were offered an opportunity to participate in this particular discussion and as such the ensuing communication could have been or would have been considered confidential by S1. If the communication was confidential then R1 would not have the right to record S1 without S1’s consent making the allegation UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. No Deficiencies cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator and CEO. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 26, 2025 · control 21-AS-20250108100016

Allegation investigated: Facility is not following the continuing care contract for residents in care.

On 02/26/2025, Licensing Program Analyst (LPA) Felias arrived at facility unannounced to deliver findings related to the above listed allegations. LPA met with Health Services Administrator, Paul Duranczyk, and CEO, Nicole Mashburn, and explained the purpose of today’s visit. The California Department of Social Services (the Department) received a complaint related to maintenance being withheld in and around the Residential Living Unit for Resident 1 (R1) as an act of retaliation. During the course of this investigation the Department reviewed records including but not limited to a Villa Marin Residency Agreement for R1, community resident rosters, community staff rosters, email communications, 3rd party structural engineers and photographs. Interviews were also conducted with community residents, current community staff and former community staff. A physical inspection of the facility site was also conducted. Continued on LIC9099C Unfounded Continued from LIC9099 Villa Marin is an unusual Continuing Care Retirement Community (CCRC) in that it is a condominium where every resident/owner owns a residential unit plus one 224th of the Independent Living common areas, and the Assisted Living and Skilled Nursing Facilities. The CCRC Provider is the Homeowners’ Association, which holds the Certificate of Authority to enter into continuing care agreements. The Villa Marin Care and Residence Agreement, document #2855803.3, specifies under Part I, subsection D: that “The Association will be responsible for maintaining and making all necessary repairs to the common areas, and will assist you in obtaining maintenance services for your Unit. You are responsible for maintaining your condominium, it’s fixtures and related areas.” The Agreement defines the common areas under Part II as “dining room, swimming pool and spa, gymnasium, gift shop, hair salon, gardens, library, and promenade deck for secure walking.” Part III, subsection C addresses Gardening and Maintenance and states that “the association will perform gardening, maintenance and landscape services for all common areas.” During the course of a site visit, the Department inspected the common areas and determined them to be adequately maintained. The Department also interviewed Resident 2 (R2) and Resident 3 (R3), both of whom advised they are satisfied with the way the Provider maintains the property. As the Provider, pursuant to the residency agreement, is not responsible for maintenance or landscaping of any individual resident’s condominium, the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. No Deficiencies cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator and CEO. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 26, 2025 · control 21-AS-20250107160630

Type of visit: Case Management - Annual Continuation

At approximately 9:20AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a 1-Year Required Visit and met with Director of Nursing, Bridget Geist, and Administrator, Paul Duranczyk. Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 12 residents in care and 3 staff members on-site. LPA reviewed the Facility's Staff Roster with Director of Nursing and found that all staff members on site were background cleared and associated to the facility per regulation. LPA reviewed staff and resident files, and resident medications. Staff files were found to be well organized, thorough and contained the required documentation. LPA reviewed a sample size of 5 resident files. During review, LPA observed Resident 1 and 2, (R1 and R2) did not have a negative TB test on file (deficiency cited, LIC809D, regulation 87458(b)(1)). Medication was centrally stored and secure. During medication review, LPA observed that the facility uses a written Medication Authorization Record (MAR) and a centrally stored log. LPA observed that some medications had incorrect medication expiration and fill dates, while other medications were correctly documented per regulation. LPA and Director of Nursing discussed reviewing centrally stored medication log and documentation expectations (see technical violation, LIC9102, regulation 87465(h)(6)). Administrator's Certificate for Paul Duranczyk (7010307740) was current with an expiration date of 10/26/2025. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC811 (Confidential Names), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 18, 2024

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.

Type of visit: Required - 1 Year

At approximately 1:20PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year Visit. LPA met with Director of Nursing, Bridget Geist, at approximately 1:50PM. Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 11 residents in care and 4 staff members on-site. At approximately 1:55PM, LPA reviewed the Facility's Staff Roster with Director of Nursing and found that all staff members on site were background cleared and associated to the facility per regulation. At approximately 2:00PM, LPA conducted a walk-though of the facility with Director of Nursing and observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has an Infection Control Plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for Resident use. Hot water temperatures for a sample size of 6 sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers and facility hardwired smoke/carbon detectors were last inspected July 2024. Facility's sprinkler system were last inspected February 2024. Facility's last fire drill was conducted August 2024. LPA unable to complete the Annual Inspection. Annual Continuation Visit to be conducted at a later date. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Director of Nursing. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 22, 2024

Allegation investigated: Licensee has not issued a refund to resident's authorized representative

At approximately 9:00AM, Licensing Program Analysts (LPAs) Felias and Florio arrived unannounced to continue a Complaint Investigation regarding the above allegation and met with Administrator, Paul Duranczyk. During the course of the investigation, the Department reviewed and requested documents, conducted interviews, and made observations. There is an allegation that Licensee has not issued a refund to resident's authorized representative. Review of documents show that Resident 1 (R1) passed on March 24, 2023. The investigation revealed that R1 moved from an independent condominium to a double occupancy PCU (Personal Care Unit) room on September 4, 2022. Facility documents revealed that R1’s authorized representative requested to have a single occupancy room or private room for R1. Continued on LIC9099C Unfounded Continued from LIC9099 Facility documents indicated that R1 had single room accommodation starting 10/26/2022 but did not pay at the single room rate until January 2023, creating a balance of $10,859.50. Financial statements indicated that the daily rate for March 2023 was $355 per day. Interview with Administrator and review of financial statements indicated that R1 was billed until March 23, 2023 leaving 8 days of occupancy left. This was credited in the amount of $2,849.29 which was applied to R1’s outstanding balance from November and December 2022, therefore, a refund was not issued as there was no refund due. Review of R1’s Medical Contract Version 5 dated 05/25/2016, under Part V. Covered Services and Covered Supplies stated “…SNF and PCU Care shall be in a semi-private room…” and Part VI. Exclusions stated, “The following are excluded from the Residents coverage under this contract. Their costs shall be borne by the Resident to the extent not covered by Medicare, private insurance, or other resources…surcharges for a private room are excluded…” Based on documents reviewed, interviews conducted, and observations made, this allegation is UNFOUNDED. A finding that the Complaint is Unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis. No Deficiencies cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 3, 2024 · control 21-AS-20231214130351

Type of visit: Case Management - Other

At approximately 3:00PM, Licensing Program Analyst (LPA) Felias, arrived unannounced to conduct a Case Management - Other Visit and met with Administrator, Paul Duranczyck. The purpose of the visit is to confirm an Order to Individual for Immediate Exclusion for All Facilities. The Department delivered an "immediate exclusion" notice on 02/15/2024 to facility. Per notice, Staff Member 1 (S1) cannot be allowed to work, be present and/or live in a CCL licensed facility, or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. Administrator informed LPA that S1 had been removed from the facility and from the facility's staff roster. Administrator stated they understood the notice. No Deficiencies Cited during visit. Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 27, 2024