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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286801070
Report Date: 07/07/2020
Date Signed: 07/07/2020 10:16:51 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2020 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20200414142813
FACILITY NAME:MEADOWS OF NAPA VALLEY, THEFACILITY NUMBER:
286801070
ADMINISTRATOR:PANCHESSON, WAYNEFACILITY TYPE:
741
ADDRESS:1800 ATRIUM PARKWAYTELEPHONE:
(707) 257-7885
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY:350CENSUS: DATE:
07/07/2020
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Wayne PanchessonTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Leibert contacted Administrator Wayne Panchesson for the purpose of delivering findings on this complaint. A tele-visit was conducted due to the COVID - 10 precautions. LPA did not physically visit the site. Complainant alleges that the facility illegally evicted R1 by refusing the allow R1 to return to the facility following a medical procedure. Facility alleges that the Responsible Person (RP) for R1 made the decision to place R1 in another facility following a care plan conference where there was agreement that a new placement would be best for R1. During the course of this investigation, this Department has interviewed staff and witnesses and obtained and reviewed documents. The following determinations have been made: There are differing opinions as to what transpired at the care conference; The written summary of the care conference indicates there was agreement by the parties that a new placement should be made; The conference was done by phone and the RP claims that RP did not agree to the replacement plan and did not sign the summary report; No actual signature by RP is on the report; RP did sign R1 into the new placement. Although an illegal eviction may have occurred, there is not a preponderance of evidence to prove that the alleged violation did, or did not, occur. Therefore, the complaint is UNSUBSTANTIATED
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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