286803919-8-25-2023-21-AS-BMOS-CV7T6L-20230830142720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286803919
Report Date: 08/25/2023
Date Signed: 08/25/2023 10:12:50 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
08/15/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230815110123

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:	09:59 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 on 7/22/2023 resident had a fall where they initially didn't complain of pain but started to later in the day. When resident started complaining of pain, they were not assessed immediately and not given pain medication. Resident was assessed on the following shift and was sent to the hospital where they were diagnosed with a fracture. Per interviews and document review, resident had an observed fall on 7/27/2023 and was assessed but did not complain of pain. Review of progress notes indicates that resident complained of pain in an area unrelated to their fracture location and was given pain medication approximately 7 hours after their fall.

Continued on LIC9099C

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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Control Number 21-AS-20230815110123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WATERMARK AT NAPA VALLEY, THE	FACILITY NUMBER: 286803919
	VISIT DATE: 08/25/2023

NARRATIVE

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Continued from LIC9099

It was documented that the pain medication helped. Per interviews resident was sent to the hospital the following day when staff observed swelling.

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.

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

LIC9099 (FAS) - (06/04)

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