The Watermark at Napa Valley

Type of visit: Case Management - Incident

On 06/24/2026, at approximately 12:45 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Incident inspection and met with Heidi Gallagher, Director of Nursing and William "Bryce" Groth, Maintenance Director and Designated Responsible Party. LPA is conducting a case management visit to obtain more information regarding a series of incident reports (IRs) and an SOC341 received by the Department. LPA obtained documents, made observations, and conducted interviews. On 05/13/2026, the Department received a self-reported incident report (IR) for an incident that occurred on 05/08/2026, involving Resident 1 (R1). On 05/28/2026, the Department received a SOC341 regarding an incident that occurred on 05/26/2026 involving Resident 2 (R2) where it was reported that items were taken from their room. Staff involved were ultimately terminated. On 06/09/2026, the Department received a self-reported IR regarding an elopement on 05/13/2026 of Resident 3 (R3) who per their physician's report dated 08/28/2024 is unable to leave the facility unassisted, (see LIC809D). All required parties were notified in the required time frames, R3's supervision and redirection were increased, and R3 was reassessed and was transferred to the facility's memory care unit the next day. The family ultimately moved R3 to a smaller facility due to R3's increased care needs and finances. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Designated Responsible Party and appeal of rights provided. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jun 25, 2026

87411(a) Personnel Requirements – General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on record review, self-report, and interview conducted with S1, R3 eloped from the community without staff knowledge and staff did not prevent R3 from wandering away from the facility which poses an immediate Health, Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2026

Plan of correction: Licensee to submit self-certification that an elopement prevention training has been schduled and/or completed by POC due date of 06/25/2026.

Type of visit: Required - 1 Year

At approximately 10:45 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Grant Wegner, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) and is approved for 240 residents and 129 of whom may be non ambulatory. Facility has independent living, assisted living, and memory care residents, with a Hospice waiver for twenty (20) and approval for twenty (20) bedridden residents. Facility has a delayed egress system in place. At approximately 11:40 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a three story building, with emergency evacuation chairs in place at at the top of each stairwell. Facility was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated and staff responded timely. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Closets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There are outdoor shaded seating areas and space for outdoor activities. LPA observed residents engaged in activities in common areas. Facility has internet service and an internet access device designated for resident use. Continued on LIC809-C... Continued from LIC809C... LPA observed facility's first aid kit and a supply of PPE. Fire extinguishers were observed fully charged and were last inspected 06/2025. Facility has a back up generator for emergency preparedness. At approximately 1:30 PM, LPA conducted a review of eight (8) resident files. All resident records have the required documentation per regulation. At approximately 4:30 PM, LPA and Administrator conducted a spot check of centrally stored medication and medication records which were observed stored and maintained in compliance with regulation. Facility assists with coordinating medical and dental appointments as well as transportation to and from appointments as needed. Facility does not manage P&I cash resource. Administrator Certificate for Grant Wegner: certificate number 7024855740 expires 03/10/2027. LPA will return at a later date to complete this annual inspection and will conduct a review of staff records at that time. LPA will review emergency disaster plan, emergency disaster drill log, facility's fire inspection report and obtain a copy of the facility's liability insurance. Exit interview conducted with Administrator whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 6, 2026

Type of visit: Case Management - Incident

On 03/18/2026, at approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management - incident visit and met with Grant Wegner, Administrator. LPA is conducting a case management visit to obtain more information regarding an SOC341 report received by the Department on 02/17/2026 for an incident that occurred on 02/14/2026, involving Resident 1 (R1) and Resident 2 (2). LPA conducted interviews and obtained documents. No deficiencies were cited during todays visit. Exit interview was conducted with Administrator, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Mar 18, 2026

Type of visit: Case Management - Incident

On 02/04/2026, at approximately 3:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management - incident visit and met with Grant Wegner, Administrator. LPA is conducting a case management visit to obtain more information regarding two SOC341 reports received by the Department on 01/22/2026 for two separate incidents that occurred on 01/11/2026 and 01/13/2026, involving Resident 1 (R1) and Resident 2 (2). LPA conducted an interview and obtained documents. No deficiencies were cited during todays visit. Exit interview was conducted with Administrator, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 4, 2026

Allegation investigated: Facility staff did not dispense medications as prescribed Facility staff yelled at residents

On 09/30/2025, at approximately 10:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver complaint investigation findings regarding LIC802 - Complaint Report #21-AS-20250725125922, which was received by Community Care Licensing (CCL) on 07/25/2025 regarding the allegations that facility staff did not dispense medications as prescribed and facility staff yelled at residents. LPA met with Grant Wegner, Administrator. On 07/31/2025, LPA Florio obtained documents and conducted interviews. Based on staff schedules obtained, staff interviews were conducted with Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), and Staff 4 (S4) which revealed conflicting statements about the staff not dispensing medications as prescribed and staff yelling at residents. continued on LIC9099C... Unsubstantiated continued from LIC9099... On 09/30/2025, LPA conducted further interviews with S1 and Resident 1 (R1) who was named in the complaint and both denied any knowledge of medications not being dispensed as prescribed since a prior allegation which was addressed under the facility's previous name Watermark on complaint #21-AS-20250224164341 which was received by the Department on 02/24/2025. Additionally, both denied any knowledge of staff yelling at residents. On 09/30/2025, LPA also obtained documents which revealed that none of R1's discontinued medications for a month prior to this complaint were administered after their discontinuation orders were received by 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 facility staff did not dispense medications as prescribed and facility staff yelled at residents 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.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 21-AS-20250725125922

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

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 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.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 21-AS-20250801085042

Type of visit: Case Management - Incident

On 09/15/2025, at approximately 3:15 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management - incident visit and met with Karina Loera, Memory Care Director. LPA is conducting a case management visit to obtain more information regarding an incident report and SOC341 received by the Department on 09/09/2025 for an incident that occurred on 09/07/2025, involving Resident 1 (R1) and Resident 2 (2). LPA conducted and interview and obtained documents. No deficiencies were cited during todays visit. Exit interview was conducted with Memory Care Director, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Case Management - Incident

On 7/10/2025, at approximately 3:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management - incident inspection and met with Grant Wegner, Administrator. LPA is conducting a case management visit to obtain more information regarding an incident report received by the Department on 05/23/2025 for an incident that occurred on 05/20/2025, involving Resident 1 (R1). LPA conducted and interview and obtained documents. No deficiencies were cited during todays visit. Exit interview was conducted with Administrator, whose signature on form confirms receipt of document.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Prelicensing

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... 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.the state’s words, verbatim · CDSS document, Mar 5, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 240 Census (if any clients in care): 143 Method: Telephone call with CAB COMP II Participants: Grant Wegner, Administrator; David Adams, Company President; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 6, 2025