286803919-9-15-2021-21-AS-AELT-C6VPBE-20210915111012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 286803919
Report Date: 10/14/2020
Date Signed: 09/15/2021 11:10:16 AM

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: 0	DATE:	10/14/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kelly Ording/Stefanie Thune-Barnes		TIME COMPLETED:	04:00 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 conducted a pre-licensing inspection on 10/14/2020 via tele-visit due to COVID – 19 precautions, a facility visit is not able to be conducted at this time. LPA spoke with Kelly Ording, Administrator and Stefanie Thune-Barnes, Managing Director/Executive Director, once the facility is approved for licensure. The facility has a fire clearance approval by the City of Napa for a total of 91 Ambulatory, 129 Non-Ambulatory and 20 Bedridden residents, granted on 9/30/2020. The facility has an Assisted Living, Memory Care and Independent Living component. Memory care unit has delayed egress. Alarm was activated for Memory Care Doors and determined to be functional. Resident pendant and pull cord notification system were tested and determined to be operational. LPA observed comfortable furnishings throughout the facility. The grounds were free of any apparent hazards, and exits were clear. Facility has several areas for a variety of activities indoors and outdoors for residents. Postings noted to be current and in compliance with regulations. No bodies of water or firearms. There is a secured laundry area and shared laundry options for residents at the facility. Toxins/cleaners are secured in Housekeeping cabinets, inaccessible to residents in care. LPA observed medication rooms. Medications will be locked and inaccessible to residents in care. Per Managing Director/Executive Director medication dispensing equipment will arrive within a few days of today's inspection. Kitchen had sufficient perishable and non-perishable food supply. Fire extinguishers were last inspected on 7/13/2020. Managing Director/Executive Director agreed to send LPA a copy of Fire Inspection report for facility. Hot water was checked and was within 105 degrees -120 degrees Fahrenheit in all areas of the facility. There is a dual generator on site for emergency power. Facility has emergency supplies. LPA observed evacuation chair. LPA confirmed staff referenced in Emergency Disaster Plan. Managing Director agreed to send updated Emergency Disaster Plan to LPA referencing current staff.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Angela Elliott	TELEPHONE: (470) 717-1668
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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: 10/14/2020

NARRATIVE

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LPA confirmed there are vehicles on site in the event of an evacuation. LPA discussed Provider Information Notices (PINS) from Community Care Licensing regarding Emergency Preparedness and COVID-19 mitigation plan guidelines. LPA indicated website link and pertinent PIN's would be sent to Administrator and Managing Director/Executive Director.

LPA conducted a Component III Orientation.

Pre-Licensing is complete and this facility has no apparent health hazards and/or concerns observed during this tele-inspection.

Copy of report to be sent to Administrator and Managing Director/Executive Director for signature and will be final printed upon receipt. LPA will forward a copy to the application unit in Sacramento; The application analyst will notify the applicant the status of the application.

*Signature in file

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Angela Elliott	TELEPHONE: (470) 717-1668
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

LIC809 (FAS) - (06/04)

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