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Department of
SOCIAL SERVICES

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 CHICOFACILITY NUMBER:
045001959
ADMINISTRATOR:MOMO DUOAFACILITY TYPE:
740
ADDRESS:855 BRUCE RDTELEPHONE:
(530) 566-1800
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:120CENSUS: 53DATE:
02/21/2024
UNANNOUNCEDTIME 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 CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (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)
Page: 1 of 2
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 CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (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)
Page: 2 of 2