210108102-2-26-2025-21-AS-VBEI-DERMA2-20250314092538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 210108102
Report Date: 02/26/2025
Date Signed: 02/26/2025 09:58:11 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2025 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20250107160630

FACILITY NAME:	VILLA MARIN AMBULATORY CARE UNIT		FACILITY NUMBER:	210108102
ADMINISTRATOR:	DURANCZYK, PAUL		FACILITY TYPE:	741
ADDRESS:	100 THORNDALE DRIVE		TELEPHONE:	(415) 499-8711
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	28	CENSUS: 273	DATE:	02/26/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Health Services Administrator, Paul Duranczyk, and CEO, Nicole Mashburn		TIME COMPLETED:	10:10 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

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

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 21-AS-20250107160630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VILLA MARIN AMBULATORY CARE UNIT	FACILITY NUMBER: 210108102
	VISIT DATE: 02/26/2025

NARRATIVE

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

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.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2