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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037002705
Report Date: 12/19/2024
Date Signed: 12/19/2024 01:30:48 PM

Document Has Been Signed on 12/19/2024 01:30 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/
DIRECTOR:		SKIDMORE, RICHARDFACILITY TYPE:
775
ADDRESS:823 SOUTH HIGHWAY 49TELEPHONE:
(209) 223-3845
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 60CENSUS: 28DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Rene Tang and Jodie AciertoTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 12/19/24, Licensing Program Analyst (LPA) arrived to this facility to conduct their annual inspection visit. LPA met with Program Managers, Rene Tang (PM1) and Jodie Acierto (PM2) and stated the purpose of this visit. LPA conducted the visit using the CARE Tool. 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 today's visit were 28 clients with 9 staff on duty.

LPA and the PM1 toured the physical plant. Outdoor activity area was observed to not accessible to traffic. No accessible bodies of water or fire safety hazards observed. During the visit, LPA observed day program clients to be participating in a group activities with sufficient amount of staff members present with approximate 3 client to 1 staff ratio. They were having a holiday party during this visit. 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 were observed to be clean and sanitized daily.

Poisonous substances, sharps objects and other dangerous items are observed to be locked and inaccessible to clients in care. Smoke and carbon monoxide detectors located in the hallway were observed and tested and found operational at this time. Observed were 3 fire extinguishers were last inspected on 7/23/24. First aid kit was observed to be complete. Medications are kept locked and inaccessible to clients in care. The facility is able to designate and dedicate a COVID bedroom, bathroom, and isolation area if needed. LPA observed the temperature in the hallway measured at 70 degrees F. The hot water in two bathrooms were measured at 110 degrees F.
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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: 12/19/2024
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LPA reviewed 5 staff records. All staff are fingerprint cleared and associated to this day program. 5 of 5 staff have current first aid and CPR certificates. Initial training were also reviewed.

LPA reviewed 5 client records. 2 of 5 clients did not have current Individual Program Plan (IPP) report available for review at this time. Per interview, IPP meeting was conducted and are waiting for the IPP report to be sent. Technical Advisory (TA) was provided for staff to obtain resident's IPP coversheet.

LPA also reviewed documentation of monthly fire/evacuation drills. LPA also reviewed disaster plan and TA was provided to review at least annually. Infection Control Plan was reviewed and last review was done on 2023. TA was provided to review infection control procedure at least annually. Licensee do not manage clients personal funds.

LPA requested copies of the following documents from the administrator: updated LIC500 and LIC308. A copy of current Liability Insurance was provided to the Department prior to this visit.

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

An exit interview was conducted with Rene Tang and copy of report was provided.

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

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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