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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803919
Report Date: 03/25/2021
Date Signed: 03/25/2021 07:05:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:WATERMARK AT NAPA VALLEY, THEFACILITY NUMBER:
286803919
ADMINISTRATOR:ORDING, KELLYFACILITY TYPE:
740
ADDRESS:4055 SOLANO AVENUETELEPHONE:
(707) 345-1480
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:240CENSUS: 20DATE:
03/25/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Luz ChatmanTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Elliott conducted the Post Licensing inspection via tele-visit conferencing due to COVID-19 precautions with Executive Director Luz Chatman. There are currently 10 residents in Assisted Living and 10 residents in Independent Living.

LPA/Executive Director conducted a walk through of the facility, Facility has sanitation opportunities and screening station set up at the entrance to the facility in order to comply with COVID-19 precautions.


LP A observed required postings in addition to COVID-19 required visitation postings. Facility is screening staff or essential visitors for symptoms. During the tele-visit LPA/Executive Director observed staff wearing face masks. Executive Director confirmed there are no No bodies of water or firearms on the premises. Grounds were free of any apparent hazards.

The facility has space indoors and outdoors for resident activities. A group activity was going on during the tele-visit. All facility bedrooms have all required personal accommodations. Bathrooms were equipped with non-slip floor and mats for safety. Water temperature tested at 105 and 120 degrees F. The facility uses the Sky Net System for resident use to notify staff of any care needs. System was tested and working appropriately Facility has at least two days of perishable and one week of non-perishable food available for residents in care. Medications are secured in individual apartments as well as the Wellness Center. An electronic Medication Record is maintained. Cleaning supplies are secured in the laundry room. Extra linens are stored in individual apartments. Fire extinguishers were last inspected 7/13/2020. Facility has hardwired combination smoke/ carbon monoxide detectors. LPA requested documentation of fire alarm and sprinkler system inspection.

Per Licensee, resident and staff records are maintained, and disaster drills are conducted quarterly. Administrator certificate for Kelly Ording #6002590740 expires 6/3/2021.

No deficiencies cited during this inspection. Signature is on file
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Angela ElliottTELEPHONE: (470) 717-1668
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
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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