045001959-6-10-2022-25-AS-LMUZ-CF9S86-20220610133837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 06/10/2022
Date Signed: 06/10/2022 10:24:18 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/31/2022 and conducted by Evaluator Jaclyn Avila

COMPLAINT CONTROL NUMBER: 25-AS-20220531140945

FACILITY NAME:	WINDCHIME OF CHICO		FACILITY NUMBER:	045001959
ADMINISTRATOR:	DAVID, RACHEL		FACILITY TYPE:	740
ADDRESS:	855 BRUCE RD		TELEPHONE:	(530) 566-1800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	120	CENSUS: 60	DATE:	06/10/2022
		UNANNOUNCED	TIME BEGAN:	07:50 AM
MET WITH:	Rachel David		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Staff did not provide adequate supervision to a resident while in care

INVESTIGATION FINDINGS:

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The Department met with Rachel David, Administrator unannounced to regarding the allegation above.

Licensing Program Analyst (LPA) Jaclyn Avila completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. LPA Avila ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: PAPR. Additionally, LPA Avila was screened by a staff person upon entering the facility.

This Department has reviewed LIC 602 (Physicians report) and care plan for Resident (R1) in addition to conducting interviews. R1 is independant and was not suspected to have COVID 19 and did not have a need identified to have increased supervision.

This agency has investigated the complaint alleging Staff did not provide adequate supervision. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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