286801070-6-14-2021-21-AS-AELT-C3YSS7-20210614140727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 286801070
Report Date: 06/14/2021
Date Signed: 06/14/2021 02:07:54 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:	MEADOWS OF NAPA VALLEY, THE		FACILITY NUMBER:	286801070
ADMINISTRATOR:	PANCHESSON, WAYNE		FACILITY TYPE:	741
ADDRESS:	1800 ATRIUM PARKWAY		TELEPHONE:	(707) 257-7885
CITY:	NAPA	STATE: CA	ZIP CODE:	94559
CAPACITY:	350	CENSUS: 42	DATE:	06/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mary Schramm		TIME COMPLETED:	12:30 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 9:05AM, and met with Administrator Mary Schramm. The inspection is focused on the Infection Control procedures and practices of this facility. Facility has Assisted Living, Memory Care and Independent Living areas of the facility. LPA conducted a walk-through of the facility which included Assisted Living and Memory Care with the Administrator and observed COVID-19 posters throughout both areas including hand washing signs in public restrooms. Mitigation plan has been submitted and approved by Community Care Licensing (CCL). Upon arrival, the receptionist checked LPA's temperature and LPA was asked to complete COVID-19 screening questionnaire, and visitor sign in sheet. All staff and visitors are required to complete the process as well as residents who are returning from the community. LPA conducted a walk-through of the facility with the Administrator and observed COVID-19 posters throughout the facility.Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is kept in the common areas and resident rooms at the facility except in Memory Care due to safety concerns. Per Administrator, they regularly discuss infection control with residents and staff and memos are sent to residents and responsible parties when there is a change in protocols. Staff have completed Personal Protective Equipment (PPE), infection control training and have been N-95 Fit tested. Administrator showed LPA documentation of training. Facility is cleaned daily and high touch surfaces are cleaned every two hours. Residents are encouraged 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: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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: MEADOWS OF NAPA VALLEY, THE	FACILITY NUMBER: 286801070
	VISIT DATE: 06/14/2021

NARRATIVE

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Residents are screened twice daily, staff observe for any changes. and resident's emergency contact information has been updated. Toxins are secured and inaccessible in locked areas throughout the facility. Medications were stored in a locked area making them inaccessible to residents and facility had a 30 day supply of medications. The facility has a large supply of Personal Protective Equipment (PPE) and hygiene supplies. All exit alarms on exit doors were working properly. Facility is conducting COVID-19 surveillance testing per CCL guidelines. Administrator stated that the facility is following and operating in compliance with their approved mitigation plan, and updating per new guidelines in PIN 21-28.

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. LPA and Administrator discussed client activities and visitation. Currently visits are happening in resident rooms and facility offers activities during the day for those wanting to participate.

Administrator and LPA discussed their Emergency Disaster Plan.

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: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC809 (FAS) - (06/04)

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