286803919-8-3-2021-21-AS-AELT-C5JTRS-20210803145801

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 286803919
Report Date: 08/03/2021
Date Signed: 08/03/2021 02:58:07 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, THE		FACILITY NUMBER:	286803919
ADMINISTRATOR:	ORDING, KELLY		FACILITY TYPE:	740
ADDRESS:	4055 SOLANO AVENUE		TELEPHONE:	(707) 345-1480
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	240	CENSUS: 44	DATE:	08/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Chad Rogers/Michael Van Gilst/Eadgitha Waken		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Angela Elliott arrived unannounced to conduct an Annual Inspection, today at approximately 12:30 PM. LPA was made aware there is a new Executive Director Chad Rogers. LPA met with Executive Director (ED) Chad Rogers, Health Services Director (HSD) Michael Van Gilst, and Eadgitha Waken, Wellness Nurse (WN). The inspection is focused on the Infection Control procedures and practices of this facility. Facility has Assisted Living (AL)), Memory Care (MC) and Independent Living (IL) areas of the facility. LPA conducted a walk-through of the facility which included Assisted Living and Memory Care with the ED, HSD, and WN. LPA observed COVID-19 posters throughout both areas including hand washing signs in public restrooms. Mitigation plan has been submitted to Community Care Licensing. Upon arrival, Concierge requested LPA be screened and temperature was taken electronically. All staff and visitors are required to complete the process as well as residents who are returning from the community. Facility was a comfortable temperature and exits were free from obstructions. LPA toured kitchen area with Katharine Lenane, Director of Dining Services. Food was stored and labeled appropriately with COVID-19 postings throughout the kitchen area. LPA was informed Executive Chef conducts food audits monthly and temperature logs were maintained. LPA toured 3 AL apartments that were clean and well lit and one MC apartment that was clean and well lit. Hand sanitizer is kept in the common areas. Per ED and HSD, general updates are communicated through a weekly news letter. Changes in procedures/protocols are communicated in writing to residents and via e-mail to family members and responsible parties. A Resident Council Meeting occurs monthly and issues are followed up as they arise. Staff have completed Personal Protective Equipment (PPE), hand hygiene and infection control training. N-95 fit testing is in process. Residents are required to wear masks when outside of their rooms and staff were observed to be wearing them while in the facility. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Angela Elliott	TELEPHONE: (470) 717-1668
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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, THE	FACILITY NUMBER: 286803919
	VISIT DATE: 08/03/2021

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Resident's emergency contact information has been updated. Toxins are secured and inaccessible in locked area on the first floor. Facility is disinfected daily and there is a schedule for cleaning resident apartments. Medications were stored in a locked area making them inaccessible to residents and facility had a 30 day supply of medications for residents. The facility has a large supply of Personal Protective Equipment (PPE) in various parts of the facility. All alarms on exit doors were working properly. Facility is conducting COVID-19 surveillance testing per CCL guidelines. ED and HSW indicated they were following the facility mitigation plan.
Facility is allowing residents to have meals in the dining room and furniture is set up for social distancing. Common areas are also set up for social distancing. Currently visits are happening in resident rooms or courtyard area, and there is an activity calendar that offers activities during the day for those wanting to participate.

ED and HSW Administrator and LPA discussed their Emergency Disaster Plan. LPA requested copy updated LIC 610E Emergency Plan and updated copy of LIC 500 be sent to CCL by COB 8/9/2021. LPA provided a copy of PIN 21-32 to ED and HSD.

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Angela Elliott	TELEPHONE: (470) 717-1668
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC809 (FAS) - (06/04)

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