216800977-6-5-2024-21-AS-BMOS-D6DRW5-20240619132233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216800977
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:47:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2024 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20240520093428

FACILITY NAME:	WINDCHIME OF MARIN		FACILITY NUMBER:	216800977
ADMINISTRATOR:	MARY MCCLURE		FACILITY TYPE:	740
ADDRESS:	1111 SIR FRANCIS DRAKE RD		TELEPHONE:	(415) 482-4100
CITY:	KENTFIELD	STATE: CA	ZIP CODE:	94904
CAPACITY:	55	CENSUS: 26	DATE:	06/05/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Business office Director Ravi Banwait		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not ensure residents rooms are kept in clean sanitary conditions
Staff do not ensure residents receive adequate incontinence care
Staff do not ensure safe food service practice is followed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hansen arrived unannounced to deliver findings regarding the above complaint allegations and met with Business Office Director Ravi Banwait as Administrator was unavailable.

Staff do not ensure residents rooms are kept in clean sanitary conditions- Complainant alleges there is not enough housekeeping staff for the residents, resulting in resident’s rooms being left dirty. LPA conducted visits at facility on 5/29/2024 & 5/30/2024 inspecting 5 resident rooms on the 3rd floor and 4 resident rooms on the 2nd floor. LPA’s observations revealed all bedrooms inspected were clean on both days. Documents obtained revealed only 1 housekeeper. Interviews conducted with 4 staff and a hospice employee revealed although all housekeepers left the week of 5/20/2024 other then one who is in charge of the laundry, caregivers are helping with housekeeping manager to clean the facility while new staff are being hired. Although it was alleged staff do not ensure residents rooms are kept in clean sanitary conditions may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

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 21-AS-20240520093428

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WINDCHIME OF MARIN	FACILITY NUMBER: 216800977
	VISIT DATE: 06/05/2024

NARRATIVE

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Staff do not ensure residents receive adequate incontinence care- Complainant alleges residents are not being cleaned properly after being changed out of their soiled incontinent products and there is not enough incontinent products. LPA made unannounced inspections of facility on 5/29/2024 & 5/30/2024 and observed most of the 9 resident rooms inspected had supplies of incontinence products in their bathrooms or bedrooms. LPAs interview with staff revealed they check all rooms that use these products every Friday and if a resident is low on supplies staff calls the families or if they are on Hospice, they call the hospice company. There is also a storage room on the 2^nd floor that LPA observed to have extra supplies of incontinence products (wipes, depends, gloves) and was told by staff if a resident runs out before their supplies are replaced, they can use these. The house supplies are also checked every Friday. LPAs interviews with 4 staff and one hospice employee who cares for a resident with incontinence issues revealed there has not been any issue with incontinence care supplies. Although it was alleged Staff do not ensure residents receive adequate incontinence care may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Staff do not ensure safe food service practice is followed- Complainant alleges kitchen staff do not practice safe food service by wearing hair nets. LPA conducted annual inspection on 5/29/2024 & 5/30/2024 of facility which included inspection of the kitchen area on dates inspected. The kitchen appeared to be clean as well as organized. Title 22 does not enforce kitchen staff to wear hair nets. Although it was alleged Staff do not ensure safe food service practice is followed may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

LIC9099 (FAS) - (06/04)

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