286804281-9-30-2025-21-AS-BMOS-DMMTBW-20251020143545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804281
Report Date: 09/30/2025
Date Signed: 09/30/2025 04:17:57 PM

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
08/01/2025 and conducted by Evaluator Julie Florio

COMPLAINT CONTROL NUMBER: 21-AS-20250801085042

FACILITY NAME:	CALLIGRAPHY NAPA VALLEY		FACILITY NUMBER:	286804281
ADMINISTRATOR:	WEGNER, GRANT		FACILITY TYPE:	740
ADDRESS:	4055 SOLANO AVE		TELEPHONE:	(707) 345-1480
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	240	CENSUS: 167	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Grant Wegner, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Resident did not receive timely medical
Staff do not ensure resident is adequately fed

INVESTIGATION FINDINGS:

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On 09/30/2025, at approximately 12:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver complaint investigation findings regarding LIC802 - Complaint Report #21-AS-20250801085042, which was received by Community Care Licensing (CCL) on 08/01/2025 regarding the allegations that Resident 1 (R1) did not receive timely medical and staff do not ensure Resident 2 (R2) is adequately fed. LPA met with Grant Wegner, Administrator.

On 08/06/2025, LPA Florio obtained documents and conducted interviews. Based on interviews conducted with facility staff S1 and S2, all the appropriate emergency responses were activated and implemented and CPR was performed according to direct instruction from 911 dispatched phone assistance while EMS were in route to the facility. These instructions included performing CPR in the resident's bed. Per S1, S2, and R1's Death Report dated 07/24/2025, R1 died at the hospital.

Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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-20250801085042

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: CALLIGRAPHY NAPA VALLEY	FACILITY NUMBER: 286804281
	VISIT DATE: 09/30/2025

NARRATIVE

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Continued from LIC9099...

On 09/30/2025, LPA attempted to speak via telephone with R1's spouse who was present during the incident but was unable to reach them. LPA was able to speak with R1's adult child (W1) who was contacted immediately by R1's spouse when the incident occurred. W1 states that they were close by and arrived at the facility within minutes of receiving the phone call. W1 states EMS were already present performing care upon their arrival.

On 08/06/2025, LPA obtained R2's LIC602 Physician's Report dated 04/03/2024, which revealed that R2 is not on a special diet, does not have any listed dietary restrictions, and is ambulatory. Based on an interview conducted with the dietary staff (S3) the same day, R2 submits requests to have meals in their room because they prefer not to leave their room. S3 states these meals are delivered when requested, which is usually 2-3 meals per day. On 09/30/2025, LPA conducted an interview with R2 who states that they don't like the food but that food is mostly delivered when they order it. R2 states there have been a few times that staff forget. R2 states they have a call bell that they can use to call staff and remind them or request food, but admits that they choose not to use it in these instances. R2 states that family brings food as a treat or to have their preferred snacks around, but that this is not because there is not enough food being served in the facility. Based on interviews conducted and records obtained, the department received conflicting information regarding the above allegations.

Based on interviews conducted and records obtained, the allegations that resident did not receive timely medical and staff do not ensure resident is adequately fed are UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that 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.

Exit interview conducted with Grant Wegner, Administrator, whose signature on form confirms receipt of documents.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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