045001959-2-21-2024-59-AS-KHOS-D32N45-20240304090723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 02/21/2024
Date Signed: 02/21/2024 01:04:02 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2023 and conducted by Evaluator Jaynae Boyles

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231211165302

FACILITY NAME:	WINDCHIME OF CHICO		FACILITY NUMBER:	045001959
ADMINISTRATOR:	MOMO DUOA		FACILITY TYPE:	740
ADDRESS:	855 BRUCE RD		TELEPHONE:	(530) 566-1800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	120	CENSUS: 53	DATE:	02/21/2024
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Adminstrator- Lisa Fennel		TIME COMPLETED:	12:56 PM

ALLEGATION(S):

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Staff are neglecting resident causing resident to develop multiple UTIs while in care.
Staff do not keep resident's personal information confidential.

INVESTIGATION FINDINGS:

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02/21/2024 Licensing Program Analyst (LPA) Jaynae Boyles made an unannounced visit to the facility and met with executive director. The purpose of this visit is to deliver the results of a complaint investigation.
During the interview process, LPA Boyles interviewed seven staff and the resident care director. LPA reviewed the files of four resident, including incident reports, and medical records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

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 59-AS-20231211165302

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WINDCHIME OF CHICO	FACILITY NUMBER: 045001959
	VISIT DATE: 02/21/2024

NARRATIVE

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LPA investigated the allegation, “Staff are neglecting resident causing resident to develop multiple Urinary Tract Infections (UTIs) while in care.” Among the staff members interviewed, the caregivers reported that they change the residents often and follow the policy and procedures to ensure that residents do not obtain a UTI. Of the staff members interviewed, all report the same procedure for when a UTI is suspected of a resident in care which is to contact the med tech and/or the resident care director to ensure that follow up testing and treatment is conducted for the resident.
LPA investigated the allegation, “Staff do not keep resident's personal information confidential.” Of the staff members interviewed it was reported that confidential information is kept confidential and private to ensure that there are no Health Insurance Portability and Accountability Act (HIPAA) violations.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.
An exit interview was conducted. A copy of the report was provided to the executive director.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC9099 (FAS) - (06/04)

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