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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803919
Report Date: 09/14/2023
Date Signed: 09/14/2023 01:39:20 PM


Document Has Been Signed on 09/14/2023 01:39 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:WATERMARK AT NAPA VALLEY, THEFACILITY NUMBER:
286803919
ADMINISTRATOR:GRANT WEGNERFACILITY TYPE:
740
ADDRESS:4055 SOLANO AVENUETELEPHONE:
(707) 345-1480
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:240CENSUS: 110DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Grant WegnerTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Victoria Bertozzi and Helena Rummonds arrived unannounced to conduct an Annual Required inspection and met with Administrator, Grant Wegner.

Upon arrival, LPAs initiated a tour of the facility around 10:20am and made the following observations: Tour included Assisted Living Apartments, the Memory Care Unit, kitchen, dining room, spa, salon, general activity and various common areas for residents. Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in various sinks accessible to residents in care were measured and 2 out of 11 were not within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cleaning supplies are locked in supply closets as well as mobile housekeeping carts. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation.

Fire extinguishers were last serviced July 2023. Facility has hardwired combination Smoke/Carbon Monoxide detectors located throughout the facility that are maintained by a vendor. Facility had a recent inspection by the local fire department. No alarm issues noted. Most recent fire/disaster drill was conducted July 2023.

Eight staff files were reviewed. Staff have required First Aid certificates. Administrator Certificate for Administrator Grant Wegner 6058988740 has expired but has sent in their renewal paperwork and is on the pending list.

LPAs were unable to complete inspection so will return at a later date.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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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