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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001959
Report Date: 08/31/2020
Date Signed: 09/01/2020 06:56:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
FACILITY NAME:WINDCHIME OF CHICOFACILITY NUMBER:
045001959
ADMINISTRATOR:DAVID JR, RICKYFACILITY TYPE:
740
ADDRESS:855 BRUCE RDTELEPHONE:
(530) 566-1800
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:120CENSUS: 71DATE:
08/31/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:RACHEL DAVIDTIME COMPLETED:
03:30 PM
NARRATIVE
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On 8/31/20 Donna Gurriere, Licensing Program Analyst and Rayna Bryson, Licensing Program Manager conducted an unannounced case management visit and met with Rachel David. The purpose of this visit is to provide Windchime of Chico with findings as follows.

On 8/26/20, California Department of Social Services Community Care Licensing learned while speaking to Windchime of Chico staff, Windchime rented a 15-passenger van to transport 9 Memory Care residents to a hospital in a different county. In addition to the 9 passengers, two staff were in the van totaling 11 passengers. The Department reviewed S1’s (Staff 1) driver’s license which did not reflect a passenger endorsement. Per Windchime management, staff, including management, do not have a passenger endorsement. This department confirmed with S1 she did not have a passenger endorsement and the transport took an extended amount of time due to concerns with the weight of the vehicle. This Department contacted California Highway Patrol and confirmed 10 or more passengers in a vehicle requires a passenger endorsement and if a person does so without an endorsement the driver is in violation of 12500 (b) CVC.

**continued**
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
FACILITY NAME: WINDCHIME OF CHICO
FACILITY NUMBER: 045001959
VISIT DATE: 08/31/2020
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**continued**

This department confirmed with staff that 6 of the 9 residents were dependent on wheelchairs. The van rented by Windchime did not have a wheelchair lift nor were the resident’s medical equipment transported with them. Staff manually removed residents from their wheelchairs and had to lift them up and on to bench seats inside of the van that contained 4 rows of bench seats and 2 individual seats. The van was also described as having 2 hinged doors on the passenger side with a narrow path to the back seats that staff had to utilize to get residents in and out of. Although staff who assisted in the loading of these residents were concerned about the safety of the residents, Windchime of Chico staff continued to load and transport the residents in this manner. Amongst the 9 residents transported, 2 were on hospice. Staff described 1 hospice resident (R1) as “borderline” while another staff stated, “I didn’t think this resident was going to survive the trip.” The 4 staff interviewed, who assisted in getting residents in the van, stated they felt concern over the transportation method because of how the residents were placed in the vehicle.

During the interviews staff stated the decision to utilize the van versus a medical transport vehicle was made by Milestone. The administrator Ricky David Jr stated, “I had nothing to do with that decision.”

Deficiencies are cited per California Code of Regulations, Title 22, and listed on LIC 809D. Failure to submit Proof of Corrections (POC's) by Plan of Correction date may result in civil penalties.

Exit interview conducted and a copy of report along with appeal rights were given.

SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: WINDCHIME OF CHICO
FACILITY NUMBER: 045001959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2020
Section Cited

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Only drivers licensed for the type of vehicle operated shall be permitted to transport residents.
Type A
09/01/2020
Section Cited

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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
Type A
09/01/2020
Section Cited

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Enumerated rights; severability- (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

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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.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3