286803919-1-31-2024-21-AS-VBEI-D2MQNK-20240220111912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286803919
Report Date: 01/31/2024
Date Signed: 01/31/2024 02:38:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/02/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20240102152639

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: 151	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	01:48 PM
MET WITH:	Grant Wegner, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Lack of activities provided to memory care residents
Resident records not maintained
Facility not kept clean, safe and sanitary
Resident hygiene needs not met

INVESTIGATION FINDINGS:

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On 1/31/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Grant Wegner. LPA toured the facility, reviewed resident records and made observations.

Complaint alleges a lack of activities provided to memory care residents. Upon a review of facility activity schedules and multiple facility tours of the memory care unit, LPA observed a wide variety of activities both stimulating and engaging with staff and other residents participating. Due to lack of corroborating evidence the allegations is found to be unsubstantiated.

Complaint alleges resident records not maintained with resident's (R1) physician's report not updated in a timely manner. Upon review of R1's medical records, it was found R1 did require an annually updated physician's report. However, staff provided documentation that an attempt to contact R1's primary care provider to complete R1's assessment was comleted but had been delayed.
Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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-20240102152639

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: WATERMARK AT NAPA VALLEY, THE	FACILITY NUMBER: 286803919
	VISIT DATE: 01/31/2024

NARRATIVE

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Based on interviews with Administrator and Memory Care Unit Director, the attempts to update R1's physician's report but were not completed by R1's primary care provider were consistent.

Complaint alleges facility not kept clean, safe and sanitary in addition to bedding items not cleaned. Upon a tour of the facility memory care unit and several resident bedrooms, LPA found the facility to be clean and comfortable for residents in care. In addition, the facility is equipped with an ample supply of linens and appropriate bedding. Lastly, LPA observed a proactive laundry system for resident clothing and bedding items.

Complaint alleges resident hygiene needs not met. Upon a tour of the facility, LPA observations and a review of facility bathing schedules and records, LPA found all items to be in order with no foul odors or other hygiene care requirements not met. LPA reviewed daily charting notes completed for each resident after bathing or upon refusal of bathing all of which were found to be documented by staff.

Due to inconsistent information gathered and a lack of corroborating evidence based on LPA observation, the allegations, lack of activities provided to memory care residents, resident records not maintained, facility not kept clean, safe and sanitary & resident hygiene needs not met are found to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies cited.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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