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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001959
Report Date: 09/28/2020
Date Signed: 09/28/2020 01:52:58 PM

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, RACHELFACILITY TYPE:
740
ADDRESS:855 BRUCE RDTELEPHONE:
(530) 566-1800
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:120CENSUS: DATE:
09/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:RACHEL DAVIDTIME COMPLETED:
02:00 PM
NARRATIVE
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On 09/28/2020 at 1:00 p.m., Rebecca Knight, Licensing Program Analyst conducted an unannounced case management visit and met with Rachel David, Administrator. The purpose of this visit was 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 nine (9) Memory Care residents to a hospital in a different county. In addition to the nine (9) passengers, two (2) staff were in the van totaling eleven (11) passengers. This department reviewed S1’s (Staff 1) driver’s license which did not reflect a passenger endorsement allowing them to drive a vehicle with eleven (11) people. Per Windchime management, no staff (to include management) had 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 weight of the vehicle. This department contacted California Highway Patrol and confirmed ten (10) or more passengers in a vehicle require a passenger endorsement and if a person drives a vehicle without one they are in violation of 12500 (b) CVC.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020
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 4
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: 09/28/2020
NARRATIVE
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This department confirmed with staff that six (6) of the nine (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 four (4) rows of bench seats and two (2) individual seats. The van was also described as having two (2) hinged doors on the passenger side with a narrow path to the back seats which staff had to utilize to get residents in and out of the van. 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 nine (9) residents transported, two (2) were on hospice. Staff described one (1) hospice resident (R1) as “borderline” while another staff stated, “I didn’t think this resident was going to survive the trip.” The four (4) staff interviewed, who assisted in getting residents in the van stated they felt concern over the transportation method and the way 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: 09/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 09/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2020
Section Cited

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87312 - Motor Vehicles Used in Transporting Residents Only drivers licensed for the type of vehicle operated shall be permitted to transport residents.
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This requirement is not met as evidenced by: Based on staff interviews and document review the licensee did not have a driver with a passenger endorsement transport residents which posed an immediate health and safety risk to residents in care.
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Type A
09/29/2020
Section Cited

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87468.1(a)(2) - Personal Rights of Residents in All Facilities To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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This requirement is not met as evidenced by: Based on staff interviews the licensee did not transport residents in a vehicle that met their physical needs which posed an immediate health and safety 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.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 09/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2020
Section Cited

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§1569.269(a)(6) 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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This requirement is not met as evidenced by: Based on staff interviews the licensee did not have a qualified driver transport nine (9) residents which posed an immediate health and safety 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.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4