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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037002705
Report Date: 12/11/2025
Date Signed: 12/11/2025 12:22:24 PM

Document Has Been Signed on 12/11/2025 12:22 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: 25DATE:
12/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Jodie Acierto and Renee TangTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 12/11/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility for the purpose of conducting their annual inspection. LPA met with Manager, Jodie Acierto (S1), and stated the purpose of the visit. The Administrator, Richard Skidmore, was notified and unable to be present for this visit. The co-Administrator, Renee Tang, was also notified and arrived shortly after.

Overview:This day program is licensed to served up to 60 clients, 20 of which may be non-ambulatory. Day program have 2 locations under the same building: 823 and 815 South Highway 49.

Physical Inspection: Areas inspected include, but not limited to, class rooms, bathrooms, kitchen, and outdoor areas. The hot water temperature was measured in 3 different bathroom faucets. Hot water temperatures were measure between 122 degrees Fahrenheit and 125 degrees Fahrenheit. Per interview with S1, the building owner replaced their water heater about 2 months ago. Per interview, staff do not have a record of hot water checks. Staff attempted to adjust the water heater throughout the visit but it was too low at 94 degrees Fahrenheit.

Fire extinguisher were observed in hallways and kitchen and were last inspected 8/7/2025. Smoke and carbon monoxide detectors were observed throughout. LPA observed centrally stored medications, sharp objects, toxic substance and other dangerous items were kept locked and inaccessible to residents in care.

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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 12/11/2025
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Record Reviews: Review of 5 client files was conducted. Reviews include, but not limited to, review of Admission Agreement, Physician Reports, Needs and Services Plan, and Ambulatory Status.

Review of 5 staff files were conducted. Reviews include, but not limited to, review of background clearance, first aid and CPR training, health screening, and staff training. 1 of 5 staff did not have their first aid and CPR certificate on file; 1 of 5 staff did not have their first aid certificate on file.

Documents Requested: LPA requested a copy of updated Liability Insurance Certificate, Surety Bond, LIC500, and LIC308 to be emailed to arvin.villanueva@dss.ca.gov.

Per the California Code of Regulations, Title 22, Division 6, Chapter 3, deficiencies were cited. Advisories were provided.

Exit interview was conducted. A copy of the report was provided upon exit.

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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 12/11/2025 12:22 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 12/11/2025 at 12:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COMMUNITY COMPASS, THE
FACILITY NUMBER: 037002705

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075(f)
Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews of 5 staff files, 1 of 5 staff did not have their first aid and CPR certificates on file; 1 of 5 staff did not have their first aid certificate on file. These poses potential health, safety, and personal rights risks to clients in care.
POC Due Date: 12/19/2025
Plan of Correction
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Staff that do not possess current first aid and CPR certificates cannot provide direct care and supervision to clients in care. These staff shall complete their first aid and CPR training prior to resuming their duties with clients. Proof of training shall be submitted to the Department by POC due date.
Type B
Section Cited
CCR
82088(e)(1)
(e) Faucets used by clients for personal care shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, hot water temperatures were taken in 4 different faucets. Hot water temperatures were measured between 122 degrees Fahrenheit and 124 degrees Fahrenheit. After the water heater was adjusted by staff, the temperature was 94 degrees Fahrenheit.
POC Due Date: 12/19/2025
Plan of Correction
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Staff will take the hot water temperature throughout the day and continue to adjust the water heater until temperature reaches within regulatory standard. Administrator will send the last record of the water temperature to the Department by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Arvin Villanueva
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2025


LIC809 (FAS) - (06/04)
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