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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 037002705
Report Date: 03/06/2024
Date Signed: 03/06/2024 11:55:50 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
09/12/2023 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20230912154004
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: 19DATE:
03/06/2024
UNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Richard SkidmoreTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not ensure that client's mobility needs were met while in care.
INVESTIGATION FINDINGS:
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On 3/6/2024, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this day program unannounced to deliver a complaint investigation finidng regarding the allegations noted above. LPA met with Richard Skidmore, administrator and explained the purpose of this visit.

In regards to the allegation that staff did not ensure that client's mobility needs were met while in care,
LPA Villanueva reviewed client records, interviewed staff and interviewed Valley Mountain Regional Center (VMRC) representatives. A review of Client_1 (C1) Individual Program Plan (IPP) dated 5/17/22, has an objective for Day Program that does not indicate mobility as a service and support to be provided. A review of C1’s Individual Service Plan (ISP) for Day Program report dated 5/23/23 reveals no record of C1 having mobility as a goal. Staff interviews indicate that C1 did not have mobility as a goal since attending this program. Per correspondence with VMRC representatives, mobility was not part of C1’s IPP.

Con't to LIC 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 27-AS-20230912154004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 03/06/2024
NARRATIVE
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...Con't from LIC 9099

Based on record reviews and interviews, it was unclear if staff did not ensure client’s mobility needs were met while in care. Therefore, the allegation was deemed UNSUBSTANTIATED. A complaint allegation finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited.  Exit interview was held and a copy of this report and appeal rights were provided to Administrator, Richard Skidmore.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
09/12/2023 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20230912154004

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: DATE:
03/06/2024
UNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Richard SkidmoreTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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2
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9
Staff did not ensure that client was taken on outings while in care.
INVESTIGATION FINDINGS:
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On 3/6/2024, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this day program unannounced to deliver a complaint investigation finidng regarding the allegations noted above. LPA met with Richard Skidmore, administrator and explained the purpose of this visit.

In regards to the allegation that staff did not ensure that client was taken on outings while in care, LPA Villanueva reviewed client records, interviewed day program staff and corresponded with Valley Mountain Regional Center VMRC representatives throughout this investigation. Through a review of C1's IPP dated 5/17/22 for Dday Program indicates that C1 is to go on community outings at least twice a month. A review of C1’s Day Program ISP report indicates that C1 will participate in a minimum of 4 community activities per month. Per review of C1’s care notes dated 12/20/21 to 6/28/22, staff documentation of C1’s outings occured on 12/28/21, 1/25/22, 3/1/22, 3/15/22, 3/29/22, and 6/23/22 indicating that C1 was not being provided consistent community outings as described in their IPP objective.

Con't to LIC9099-C...

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20230912154004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 03/06/2024
NARRATIVE
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...Con't from LIC 9099:

Interviews with day program staff reveal that Community Compass have been having a staffing shortage due to COVID, which prevented them from providing consistent community outings for their clients. Administrator, Richard Skidmore, disclosed to LPA and through providing supporting documentation that Community Compass has been making the effort to hire more staff in order to meet the needs of their clients. Through correspondence with VMRC representatives, it was revealed that the issue of Community Compass not providing community outings to client had been substantiated by VMRC due to not notifying C1 and their representatives a deviation in the C1's’ goal and not discussing any alternatives. In this case, the preponderance of evidence standard has been met, therefore the above the allegation that staff not ensuring that clients were taken on outings while in care is SUBSTANTIATED.

Per California Code of Regulations, Title 22, citations for deficiencies can be found on the LIC 9099 -D. Failure to correct deficiencies may result in additional civil penalties. An exit interview was held with the Adminstrator, Richard Skidmore, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230912154004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2024
Section Cited
CCR
82079(e)
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82079 Planned Activities: (e) Activities shall be designed to meet the client's specific needs and interests, as determined by the Needs and Services Plan, and shall be consistent with the program's plan of operation.
This requirement is not met as evidenced by:
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Per licensee, Community Compass has been making the efforts in hiring more staff to meet the needs of their clients.
Per licensee and through document reviews, as of today's visit, clients have been going on outings on a more consistent basis.
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Based on record reviews and interviews, licensee did not ensure C1's IPP objective for community outing was met and did not notify and had a meeting with C1 and their support a deviation of the objective was implemented, which posed a potential health, safety or personal rights risk to persons in care.
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Licensee to submit a written plan in case a deviation of clients' IPP/ISP objective(s) is/are needed. The written plan to be submitted to the Department by the POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5