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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037002705
Report Date: 10/21/2021
Date Signed: 10/21/2021 12:31:48 PM

Document Has Been Signed on 10/21/2021 12:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:COMMUNITY COMPASS, THEFACILITY NUMBER:
037002705
ADMINISTRATOR:SKIDMORE, RICHARDFACILITY TYPE:
775
ADDRESS:823 SOUTH HIGHWAY 49TELEPHONE:
(209) 223-3845
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 60CENSUS: 16DATE:
10/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Richard SkidmoreTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) C.Valerio arrived at this facility unannounced to conduct an annual inspection visit. LPA Valerio introduced herself, explained the purpose of the visit, and was met by Administrator Richard Skidmore. LPA Valerio was screened for COVID-19 symptoms with temperature prior to being allowed inside the facility. Administrator confirmed no staff or consumers have displayed any signs or symptoms of COVID-19 in the last 10 days.
 
The physical plant was toured inside and outside to ensure the safety of the consumers and compliance with Title 22 regulations. LPA also conducted the infection control domain tool. The facility has a LIC 808 mitigation plan uploaded into FAS. LPA observed the facility to have COVID-19 informational signs, social distancing signs, hand washing signs posted throughout the facility. LPA observed a 30-day supply of PPE. The facility is able to designated and dedicated a Covid-19 bedroom, bathroom, and isolation area if needed.
 
LPA observed the temperature inside the facility was measured at 72*F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 115.9*F, which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).  LPA observed cleaning supplies to be locked and inaccessible to clients. The facility common areas were clean and furnished. Activities areas are clean and sanitized daily. Facility has plastic dividers in place to promote social distancing. Fire extinguisher is up to date with last check on 06/28/2021.

LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility and LIC 500 personnel report
 
Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left with the Administrator.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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