045001959-7-9-2025-59-AS-KHOS-DJES83-20250709133827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001959
Report Date: 07/09/2025
Date Signed: 07/09/2025 12:20:27 PM

Substantiated

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
04/01/2025 and conducted by Evaluator Kayla Adkison

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20250401110543

FACILITY NAME:	WINDCHIME OF CHICO		FACILITY NUMBER:	045001959
ADMINISTRATOR:	MORRIS, MARK		FACILITY TYPE:	740
ADDRESS:	855 BRUCE RD		TELEPHONE:	(530) 566-1800
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	0	CENSUS:	DATE:	07/09/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Delivered findings via Postal Mail		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Personal Rights - Staff are allowing residents to smoke outside of the designated smoking area which violates the personal rights of other residents.

INVESTIGATION FINDINGS:

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On July 9, 2025, Licensing Program Analyst (LPA) Kayla Adkison delivered complaint findings via postal mail due to the facility closing on May 1, 2025.

During the investigation process, interviews were conducted, observations were made, and documents were collected from the facility. Interviews were conducted with the interim and current administrators and prior and current staff. Documents collected included the resident handbook, the resident admission agreement, and a staff roster.

Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 475-5882
LICENSING EVALUATOR NAME: Kayla Adkison	TELEPHONE: 916-208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

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-20250401110543

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: 07/09/2025

NARRATIVE

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Personal Rights - Staff are allowing residents to smoke outside of the designated smoking area.

On April 1, 2025, a complaint was filed alleging staff were allowing a resident to smoke within 25 feet of the entry doors to the facility, thus violating the facilities smoking policy and other residents’ personal rights. During the interview process, it was stated that the only area approved for residents to smoke is in the courtyard.

On April 11, 2025, LPA observed signs stating “no smoking within 25 feet” on each door leading from the courtyard to the facility. LPA did not observe any ash trays or “cigarette butts” in the courtyard.

During the investigation, it was reported by several individuals that a resident has been observed smoking throughout the courtyard within the 25-foot limit of the exit/entry doors as well as within the resident’s room. It was further stated that when attempting to redirect the resident, the resident would become upset, and management directed staff to “just let it be.” Additionally, it was noted that this resident is an oxygen user, and the facility was not taking appropriate measures to keep this resident and others safe by allowing them to smoke in their room with oxygen in use.

Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.

Due to the facility's closed status, a copy of this report and Appeal rights have been sent via postal mail to the licensee's last recorded mailing address.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 475-5882
LICENSING EVALUATOR NAME: Kayla Adkison	TELEPHONE: 916-208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250401110543

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/09/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/09/2025 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 - Personal Rights of Residents in All Facilities (a) Residents in all residential care faciliteis for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful, and comfortable accomodations.. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	A plan of correction is not being assigned for this complaint as the facility has been closed. A copy of this report has been sent via postal mail to the licensees last recorded address for their personal records.
	8 9 10 11 12 13 14	Based on interviews, observations, and records obtained the licensee/administrator did not provide safe,healthful, and comfortable accomodations by allowing one (1) resident to smoke within 25 feet of an exterior door. This poses an immedaite risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lauren Crocker	TELEPHONE: (916) 475-5882
LICENSING EVALUATOR NAME: Kayla Adkison	TELEPHONE: 916-208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

LIC9099 (FAS) - (06/04)

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