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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286801070
Report Date: 01/30/2026
Date Signed: 02/27/2026 04:46:47 PM

Substantiated


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
10/24/2025 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20251024124228
FACILITY NAME:MEADOWS OF NAPA VALLEY, THEFACILITY NUMBER:
286801070
ADMINISTRATOR:KRISTINE MORROWFACILITY TYPE:
741
ADDRESS:1800 ATRIUM PARKWAYTELEPHONE:
(707) 257-7885
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY:350CENSUS: 56DATE:
01/30/2026
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Krisitne Morrow, Executive DirectorTIME COMPLETED:
06:20 PM
ALLEGATION(S):
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Staff are not following reporting requirements
INVESTIGATION FINDINGS:
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***AMENDED DOCUMENT DUE TO REPORT INDICATING WRONG FINDING***

On 01/30/2026, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver complaint #21-AS-20251024124228 investigation findings and met with Kristine Morrow, Executive Director. Reporting Party (RP) alleges staff are not following reporting requirements.

LPA conducted 10-day complaint investigation visit on 10/27/2025 and obtained documents. Per an Unusual Incident/Injury Report received by the Department on 10/21/2025, on 10/16/2025, Resident 1 (R1) sustained a fall that resulted in the activation Emergency Medical Services (EMS). R1's Admissions Agreement dated 08/27/2024, Emergency Identification form dated 08/20/2024, Advanced Health Care Directive (AHCD) dated 05/09/2023, and Health Information Portablity and Accountability Act (HIPAA) form dated 05/03/2023, are all signed by R1 and name R1's son as the responsible party/agent/respesentative. Both R1's AHCD and the HIPAA state they are effective immediately upon their execution. On 01/30/2026, LPA obtained additional documents and conducted an interview with Executive Director where it was revealed that R1's responsible party was notified via telephone/text message only intially. A written report was not provided to the responsible party until 11/14/2025 along with copies of the rest of R1's records.

Per California Code of Regulation (CCR) section 87211(a)(1)(B), "A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. [...] Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision."


It was discused with Executive DIrector that per CCR section 87101(r)(6) "Responsible Person" means "Representative," as defined in Section 87101(r)(3), for purposes of these regulations and applicable statutes. Further, per CCR 87101(r)(3) "Representative" means an individual who has authority to act on behalf of the resident; including but not limited to, a conservator, guardian, person authorized as the agent in the resident’s valid advance health care directive, the resident’s spouse, registered domestic partner, family member, a person designated by the resident, or other surrogate decisionmaker designated consistent with statutory and case law [...].

Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20251024124228
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: MEADOWS OF NAPA VALLEY, THE
FACILITY NUMBER: 286801070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2026
Section Cited
CCR
87211(a)(1)
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Reporting Requirements 87211(a)(1): A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence [....].
This requirement is not met as evidenced by:
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Licensee shall self certify that they will ensure that the required written reports are submitted to all the required parties within the required seven day reporting timeframe to CCLD by POC due date 02/27/2026.
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Based on records reviewed and interviews conducted, Licensee did not ensure that R1's responsible party received a written report of the incident that occurred on 10/16/2025 within seven days of the occurence which poses a Health, Safety and/or Personal Rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20251024124228
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: MEADOWS OF NAPA VALLEY, THE
FACILITY NUMBER: 286801070
VISIT DATE: 01/30/2026
NARRATIVE
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Continued from LIC9099...

Based on observations made, interviews conducted and records obtained, the allegation staff are not following reporting requirements is SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency is cited from Title 22 Regulations, Division 6, (see LIC9099D).

Exit interview conducted with Executive Director, whose signature on form confirms receipt of documents. Copy of report and appeal rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3