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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037002705
Report Date: 12/20/2023
Date Signed: 12/20/2023 03:46:45 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/20/2023 03:46 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 23DATE:
12/20/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Richard Skidmore, AdministratorTIME COMPLETED:
01:45 PM
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On 12/20/2023, at 10:45am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. Note that LPA is unable to open the required 1 year evaluation option and LPA conducted the visit using a printed CARE Tool. LPA met with the administrator, Richard Skidmore, and explained the purpose of today’s visit. The facility is currently licensed to serve 60 adults age 18 years old and above, of which 20 non-ambulatory clients has been approved. Present during this visit, there were 7 clients in care with 3 staff on duty including the administrator. Facility has submitted an infection control plan.

At 11am, LPA and the administrator toured facility and grounds. No accessible bodies of water or fire safety hazards observed. During the visit, LPA observed day program clients to be participating in a group activity with sufficient amount of staff members present to assist clients. LPA toured the facility inside including but not limited to facility activity rooms, conference room, and kitchen area. LPA observed 4 facility bathrooms to be clean and odor free and equipped with liquid soap and paper towels. One bathroom is located in the kitchen area. One bathroom in the activity room. The other two bathrooms are are located in the hallway and each of the two bathrooms have 2 stalls. Kitchen was observed to be clean and free from flies and pests. Clients belongings were observed to be stored. The facility common areas were clean and furnished. Activities areas are clean and sanitized daily.





{Con't to LIC809-C}
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COMMUNITY COMPASS, THE
FACILITY NUMBER: 037002705
VISIT DATE: 12/20/2023
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{Con't from LIC809}

Toxins, cleaning supplies, and sharps are observed to be locked and inaccessible to clients in care. Smoke and carbon monoxide detectors located in the hallway were observed as operational. Observed were 3 fire extinguishers were last inspected on 7/19/2023. First aid kit was observed to be complete. Medications are kept locked and inaccessible to clients in care. 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 70 degrees F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 106 degrees 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 reviewed five (5) staff records and five (5) client records. All staff are fingerprint cleared and associated to this day program. Additionally, review of staff records shows current first aid and CPR certificates. All clients have required documents for community care licensing (CCL). LPA also reviewed documentation of monthly fire/evacuation drills. LPA requested copies of the following documents from the administrator: updated liability insurance, LIC500 and LIC308.

No deficiencies cited per California Code of Regulations, Title 22, Division 6, Chapter 8

An exit interview was conducted with administrator, Richard Skidmore, and copy of report was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC809 (FAS) - (06/04)
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