045001959-3-9-2023-25-AS-APEZ-CPZTPQ-20230317145444

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:30:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2022 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20221207104729

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: 64	DATE:	03/09/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Executive Director: Jacob Primeau		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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- Facility does not provide residents activities.
- Facility does not provide residents linen services.

INVESTIGATION FINDINGS:

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On 03/09/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding Community Care Licensing received on 12/07/2022. LPA met with Executive Director, Jacob Primeau, and explained the purpose of the visit. LPA ensured the following Personal Protective Equipment (PPE) was worn surgical mask. LPA were screened by facility staff and washed hands prior to entering the facility.

During the course of investigation, the Department interviewed residents, facility staff, and obtained pertinent documents relevant to the complaint investigation such as, activities calendars, and updated linen services policy.

Continue on page LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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-20221207104729

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: WINDCHIME OF CHICO	FACILITY NUMBER: 045001959
	VISIT DATE: 03/09/2023

NARRATIVE

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Allegation- Facility does not provide residents activities. Unsubstantiated.

According to complainant, facility is taking away activities from residents in care.

The Department received activities calendar for the assisted living side and memory care side for the month of December of 2022. Interview statement received from Activities Director, Renee Walker, indicated the facility will follow the activities calendar for the month, but often would improvise due to lateness or cancelations. Activities Director stated, it’s everyone’s responsibility to assist and provide activities to residents and it’s not just Activities Director’s duties. It’s the caregivers’ duties to follow through on activities with residents and if residents don’t want to participate then caregivers has to provide alternative activities that resident would like.

On 12/14/2022, LPA Keosavang toured the facility and observed residents in the assisted living unit listening to a live band. LPA observed residents in the memory care unit building a gingerbread house with staff. The Department received interview statements from three (3) residents. R1 indicated is a new resident at the facility. R1 participates in activities such as puzzles, knitting, crocheting, oil painting, and read. Interview statement received from R2 indicated, R2 participates often in activities provided by the facility. R2 likes to go to the lobby on Fridays and listen to a live band. Interview statement received from R3 indicated, the facility would provide music. Someone would come to the facility and play the piano or the guitar. R3 stated the facility provides activities such as bingo, classes, exercise, bible study, and more. R3 indicated most residents do no want to participate.

Allegation - Facility does not provide residents linen services. -Unsubstantiated.

According to complainant, a letter was sent out in August of 2022 to residents and their families stating facility will be raising rent, care cost, medication fees, and linen services. Interview statement received from R4’s responsible party indicated the facility did not provide R4 linens for bed.

Continue on LIC 9099-C.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20221207104729

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: WINDCHIME OF CHICO	FACILITY NUMBER: 045001959
	VISIT DATE: 03/09/2023

NARRATIVE

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On 12/6/2022, the Department received a letter stating there has been a change of schedule fees as of November 2022 from the facility’s Vice President, Compliance, and Regulatory Affairs. The facility may change these fees upon 60 days’ written notice. On 11/30/2022, residents and their responsible party received a letter from the facility stating effective on 01/01/2023, they will be discontinuing current linen services that is provided to the residents and families when they move in and during their residency in the community. The facility will still continue the washing and drying of resident linens but will no longer have an in-house supply of linens for resident use. The facility recommended that residents and families purchased linens for themselves and have extra on hand for when staff change their linens when needed. If residents are needing the community to get these items due to lack of time, we can purchase linens for residents and bill back to their account.

Due to the information above, CCL finds the allegations to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted with Executive Director, copy of report was provided via email.

An exit interview was conducted, and a copy of the report left at the facility.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

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