045001959-11-10-2020-25-AS-RLBN-BVAUMF-20201112144215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 11/10/2020
Date Signed: 11/10/2020 03:01:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2020 and conducted by Evaluator Jaclyn Avila

COMPLAINT CONTROL NUMBER: 25-AS-20200413121112

FACILITY NAME:	WINDCHIME OF CHICO		FACILITY NUMBER:	045001959
ADMINISTRATOR:	DAVID JR, RICKY		FACILITY TYPE:	740
ADDRESS:	855 BRUCE RD		TELEPHONE:	(530) 566-1800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	120	CENSUS: 57	DATE:	11/10/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Rachel David, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Residents are soiled for an extended period of time
Staff failed to address residents change in medical condition

INVESTIGATION FINDINGS:

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On 11/10/20 at 2:45 PM, Licensing Program Analyst (LPA) Jaclyn Avila, contacted the facility via telephone and spoke with Administrator Rachel David. The purpose of the call was to deliver complaint findings via telephone due to COVID-19 and pre-cautionary measures

California Department of Social Services Community Care Licensing received a complaint alleging staff left residents soiled for an extended period of time and staff failed to address residents change in medical condition. This department did not receive any documentation to support these allegations. Residents needs were documented to be addressed. Staff interviews did not contradict this. Residents involved were not available for contact.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
No citations issued on today’s date.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020

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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