286803919-8-25-2023-21-AS-BMOS-CV7T9F-20230830143152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286803919
Report Date: 08/25/2023
Date Signed: 08/25/2023 10:14:50 AM

Unsubstantiated

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
07/10/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230710103509

FACILITY NAME:	WATERMARK AT NAPA VALLEY, THE		FACILITY NUMBER:	286803919
ADMINISTRATOR:	GRANT WEGNER		FACILITY TYPE:	740
ADDRESS:	4055 SOLANO AVENUE		TELEPHONE:	(707) 345-1480
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	240	CENSUS: 108	DATE:	08/25/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator, Grant Wegner		TIME COMPLETED:	10:22 AM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts Bertozzi and Rummonds arrived unannounced to deliver findings regarding the above allegation and met with Administrator, Grant Wegner.

Staff did not seek timely medical attention for a resident – Complaint alleges that resident had a fall on 07/01/2023 and facility staff did not assess resident for injuries or seek medical attention despite resident complaining of pain. Per interviews and review of resident progress/chart notes, resident experienced a fall on 7/2/2023, was assessed and based on assessment, did not exhibit symptoms requiring them to be seen by a doctor. There was not a fall documented on 7/1/2023.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited during this investigation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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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