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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804281
Report Date: 03/05/2025
Date Signed: 03/05/2025 05:05:51 PM

Document Has Been Signed on 03/05/2025 05:05 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:
286804281
ADMINISTRATOR/
DIRECTOR:		WEGNER, GRANTFACILITY TYPE:
740
ADDRESS:4055 SOLANO AVETELEPHONE:
(707) 345-1480
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 240CENSUS: 150DATE:
03/05/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Grant Wegner, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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At approximately 12:00 PM, Licensing Program Analysts (LPAss) Julie Florio and Ethel Conteras arrived unannounced to conduct a Pre-Licensing visit and met with Grant Wegner, Executive Director. Applicant has applied for a Change of Ownership for an existing Residential Care Facility for the Elderly (RCFE) identified as The Watermark at Napa Valley 286803919.

At Approximately 12:30 PM, LPAss conducted a physical plant walk-through and observed the following: The facility is a three-story facility with independent living, assisted living and memory care residents. Facility was found to be clean with all exits free from obstruction. Facility had emergency lighting. LPAs observed required postings including the CCL complaint poster, personal rights poster, and a long-term care ombudsman poster. Facility has an Infection Control plan and Emergency Disaster Plan on file. LPAs observed a supply of at least two (2) days of perishable and and seven (7) days of nonperishable foods as required by Title 22 Regulations. Emergency evacuation chairs, emergency supplies, water, and a first aid kit were observed. Toxins were observed to be stored inaccessible to residents. Hot water temperatures tested within Title 22 Regulations of 105 to 120 degrees Fahrenheit. Facility received an approved fire clearance on 11/21/2024 for 91 Ambulatory, 129 Non-Ambulatory residents, and 20 bedridden residents. Fire extinguishers were observed charged.

At approximately 2:00 PM, LPAs conducted file review and found the following: staff files reviewed had current First Aid and CPR certifications as well as all the required paperwork. Resident files reviewed had all the required paperwork. Medication was observed to be centrally stored and secure.

At approximately 4:40 PM, LPAs conducted Component III with Applicant. LPAs notified Applicant that once licensed, they will need to complete a new Admission Agreement and Care Plan for the current resident in care.

No Deficiencies cited during today's Pre-Licensing visit which is now complete. Facility is ready to be Licensed as a Residential Care Facility for the Elderly.

Continued on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: WATERMARK AT NAPA VALLEY, THE
FACILITY NUMBER: 286804281
VISIT DATE: 03/05/2025
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Continued from LIC809...

LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status.

Exit interview conducted with ED, whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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