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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286801070
Report Date: 03/23/2022
Date Signed: 03/23/2022 03:42:10 PM


Document Has Been Signed on 03/23/2022 03:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



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: 40DATE:
03/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:AL Director, Mary SchrammTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced to conduct a case management inspection on 3/23/2022. LPA met with assisted living director Mary Schramm.

This case management inspection is a follow up to an incident report received on 01/26/2022. Resident had been complaining of chest pain and was given medication by his wife. LPA reviewed LIC 602 which indicated resident is able to manage own medication. LPA confirmed medication was on medication list.

There had also been a report of scabies in the independent living part of the facility. Assisted living and memory care are in a separate building. There were never any cases of scabies in AL and the IL case was contained.

Exit interview conducted with AL director, and a copy of this report emailed to the facility.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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