045001959-8-17-2022-25-AS-LMUZ-CJGPG7-20220921111751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 08/17/2022
Date Signed: 08/17/2022 07:59:12 PM

Substantiated

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
08/11/2022 and conducted by Evaluator Jaclyn Avila

COMPLAINT CONTROL NUMBER: 25-AS-20220811130347

FACILITY NAME:	WINDCHIME OF CHICO		FACILITY NUMBER:	045001959
ADMINISTRATOR:	VONWAL, JEFFREY		FACILITY TYPE:	740
ADDRESS:	855 BRUCE RD		TELEPHONE:	(530) 566-1800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	120	CENSUS: 53	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Jeffrey Vonwal		TIME COMPLETED:	08:15 PM

ALLEGATION(S):

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Facility not kept clean and sanitary

INVESTIGATION FINDINGS:

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On 08/17/2022 at 8:05 AM, Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility unannounced to conduct a complaint investigation. LPA met with Administrator Jeff Vonwal and explained the purpose of the visit. Prior to initiating the complaint investigation LPA completed 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 ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: PAPR

This Department has investigated the above allegtion and determined it to be substantiated. The investigation consisted of interview and observation.

See LIC 9099-C

Substantiated

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: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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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Control Number 25-AS-20220811130347

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WINDCHIME OF CHICO	FACILITY NUMBER: 045001959
	VISIT DATE: 08/17/2022

NARRATIVE

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This Department conducted a tour of the memory care unit within the facility with the Administrator at approximately 8:20 AM. This Department observed the following:

Inside the kitchenette refrigerator observed uncovered cups that contained liquid, Expired milk as of 8/12/2022. Next to the kitchenette was a a laundry room concealed with a shower curtain. The Department opened the shower curtain and observed a pile of clothing, mixed with towels, a shoe, hair roller, boxes, adds and oak picture frames. Administrator said he did not know but assumed clothes were clean. When the Department requested an affirmative answer. Administrator called over a caregiver and asked what the pile was. The caregiver shrugged their shoulders and said they didn't know. The caregiver said they believed it was a mix of resident items. This Department did not observe soiled items separated from clean items as per regulation 87303 Maintenance and Operation(g) Facilities which have machines and do their own laundry shall: (1) Have adequate supplies available and equipment maintained in good repair. Space used to sort soiled linen shall be separate from the clean linen storage and handling area.

On the floor outside of the laundry room, The Department observed bags of garbage to include soiled depends. The space where the kitchenette and laundry room is located is a community space. The Department observed multiple residents sitting in this community area watching the TV that was playing music. During the tour of the kitchenette in the memory care unit this Department observed multiple cleaning solutions in the cabinet under the sink that was not locked. Solutions were labeled Multi-purpose and glass cleaner. Citations to be issued on a LIC 809 Facility Evaluation form.

The Department toured the community bathroom in memory care. The bathroom smelt of urine.

Based on LPA's observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. The following deficiencies were cited per Title 22 of the California Code of Regulation (See LIC 9099D). Appeal Rights were explained and provided to the facility representative listed above and an Exit Interview was conducted. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20220811130347

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WINDCHIME OF CHICO	FACILITY NUMBER: 045001959
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/18/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Licensee agrees to provide a plan of correction to LPA after consulting with Milestone. Licensee agrees to discuss and provide the plan to LPA by 10 AM on 8/18/2022.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based upon observation and interview the Licensee failed to keep the memory care unit clean, safe and santitary This poses an immediate Health, Safety and/or Personal Rights risk to clients in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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