The Watermark at Napa Valley

COMPLAINT INVESTIGATION REPORT

This report details a complaint investigation regarding staff adherence to infection control requirements. The investigation found that the allegation was unsubstantiated based on facility observations and record reviews. No deficiencies were cited during this inspection.

The facility was visited for a case management review following an unusual incident report. The investigator noted that the facility conducted an investigation and implemented changes regarding key storage. No citations were issued during this visit.

The inspection was a Case Management visit following a reported medication error on 11/10/2024. The primary deficiency cited relates to medication administration, where the facility did not ensure the correct medication was given as ordered. This is flagged as a Type A violation due to the immediate health risk and is noted as a repeat violation.

The inspection was a Case Management visit following a reported medication error. Two critical deficiencies were cited related to medication administration, specifically failing to assist with self-administered medications and administering a discontinued drug. These issues represent immediate health risks and require prompt corrective action.

The facility underwent a required Annual inspection and was generally found to be compliant. Inspectors noted that the facility has required plans in place, and all reviewed resident records were up to date. The only area noted for follow-up was that five of ten staff records lacked documentation of required training, which the facility is actively addressing.

The inspection was a case management follow-up regarding a self-reported elopement incident. Two Type A deficiencies were cited related to staff competency and insufficient staffing levels, specifically concerning a resident with known cognitive impairment who eloped from the facility. Immediate corrective action is required regarding staff training and protocols for residents unable to leave unassisted.

This report details a complaint investigation conducted on 01/31/2024 regarding several allegations. All cited allegations—lack of activities, resident record maintenance, cleanliness, and hygiene needs—were found to be unsubstantiated based on the evidence reviewed during the visit. Consequently, no deficiencies were cited in this report.