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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286801070
Report Date: 06/09/2022
Date Signed: 06/09/2022 12:53:14 PM


Document Has Been Signed on 06/09/2022 12:53 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: 43DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:AL Administrator Mary SchrammTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA), Erik Gonzalez Campos arrived unannounced to conduct a Required-1 Year Inspection and met with Assisted Living Administrator, Mary Schramm. The inspection is focused on the Infection Control procedures and practices of this facility.

Facility is a CCRC with assisted living, independent living, skilled nursing, and memory care. LPA conducted a walk-through of the facility with the administrator and observed COVID-19 posters throughout. Mitigation plan has been submitted and approved by Community Care Licensing (CCL).

Upon arrival at the facility LPA was screened for COVID and asked to present proof of vaccination. All staff and visitors were observed wearing masks. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is available throughout the facility. Per Administrator, they regularly discuss infection control with residents and staff. Memos are sent to residents and responsible parties when there is a change in protocols. Staff have completed Personal Protective Equipment (PPE)/infection control training and have been N-95 Fit tested. High touch surfaces areas are cleaned multiple times per shift. Residents are encouraged to wear masks and to socially distance during group activities and when they are outside their bedrooms.

All staff and residents are vaccinated, therefore facility is not currently conducting surveillance testing. Residents are screened twice daily, staff observe for any changes. Resident's emergency contact information is kept updated. Toxins are secured and inaccessible in locked areas throughout the facility. Medications are stored in a locked area making them inaccessible to residents and facility has a 30 day supply of medications. The facility has a large supply of Personal Protective Equipment (PPE) and hygiene supplies.

Continued on LIC 809C
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, THE
FACILITY NUMBER: 286801070
VISIT DATE: 06/09/2022
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Facility is allowing residents to have meals in the dining room and furniture is set up for social distancing. Common areas are also set up for social distancing. LPA and Administrator discussed client activities and visitation.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
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