045001756-7-17-2020-25-AS-JAVA-BRLUUZ-20200717155422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045001756
Report Date: 07/17/2020
Date Signed: 07/17/2020 03:54:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME:	COMPASS ROSE		FACILITY NUMBER:	045001756
ADMINISTRATOR:	FREUDENDAHL, TRACY		FACILITY TYPE:	740
ADDRESS:	2750 SIERRA SUNRISE TERRACE		TELEPHONE:	(530) 774-2705
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	48	CENSUS: 21	DATE:	07/17/2020
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Tracy Freudendahl		TIME COMPLETED:	03:00 PM

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On July 17, 2020, a tele-visit Zoom conference meeting was held today due to COVID-19 and pre-cautionary measures regarding a stipulation and order. Present at the meeting are Tracy Freudendahl, Brad Azevedo, Rob Henderson, Dee Navarro, Andy Plant, Michael O'rourke, Licensing Program Analyst Jaclyn Avila, Licensing Program Manager Rayna Bryson, Licensing Program Manager Laura Munoz, and Regional Manager Alycia Berryman.

The purpose of this meeting is to discuss the Stipulation and Waiver; and Order issued by the California Department of Social Services was adopted on June 23,2020. The stipulation and waiver and order were discussed, to all present in the meeting acknowledges said document and agrees to abide by the contents set forth in said stipulation and waiver and order.

The Stipulation, Waiver & Order details are as follows:

· The Respondents shall operate the facility in strict compliance with the regulations and statutes governing the operation of a residential care facility for the elderly.

· The Revocation of the license shall be stayed, for three (3) years during which time Respondents shall be granted a probationary license subject to the following limitations and conditions.
· During the probationary period the Department in its sole discretion may conduct unannounced site visits for the purpose of determining whether there is full compliance with the regulations and statues governing the operation of a residential care facility for the elderly.
· The Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period. All residents shall be notified of the Stipulation, Waiver and Order.
· Respondents shall ensure, pursuant to Health and Safety Code section 1569.17, that individuals working or volunteering in the facility shall obtain criminal record clearances or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility.

Continued on page LIC 809-C.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2020

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
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COMPASS ROSE	FACILITY NUMBER: 045001756
	VISIT DATE: 07/17/2020

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· Respondents shall accurately report to the Licensing office the following: any unusual incident including, but not limited to, client death or serious injury which requires medical treatment, any suspected physical or psychological abuse of any client, any substantial physical plant changes, and all client elopements.

· Respondents shall provide, at least monthly, to all current and new direct care employees and managers, training on applicable Health and Safety statues and Title 22 regulations. Medication training shall be provided by a registered nurse licensed in the State of California. Records of this training must be kept on file at the facility for inspection by licensing.

· There shall be a minimum of three (3) qualified direct care employees in the memory care unit during the morning and evening shifts, not including the person responsible for dispensing medications. There shall be a minimum of two (2) qualified direct care employees in the memory care unit during the overnight shift, not including the person responsible for dispensing medications. In the event of a substantial deduction in the census, Respondents may request a reduction in minimum staffing ratios from licensing. In the event of a substantial increase in the census, licensing may increase minimum staffing ratios.

· Respondents shall ensure that all employees who provide direct care to clients shall have the initial annual training pursuant of Title 22 Regulations section 87411.

· Respondents shall ensure that all clients with a diagnosis of dementia are checked on by caregivers every fifteenth (15) minutes whenever any of these clients are in outside courtyards at the facility. Further, facility managers shall make random checks, at least three (3) times a week, to ensure that caregivers are complying with this requirement. A written log of the fifteen minute checks shall be kept by the facility and available for inspection by licensing.

Continued on LIC 809-C

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2020

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
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COMPASS ROSE	FACILITY NUMBER: 045001756
	VISIT DATE: 07/17/2020

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The Respondent shall submit the following to the licensing office no later than July 31, 2020:

The Respondent shall develop a yearly training schedule for direct care staff which include, but are not limited to, the following topics:

· Reporting requirements

· Observation of changes in client conditions
· Lack of hazard awareness in people with Dementia
· Job duty expectations of direct care employees
· Direct care employees duty to notify co-workers when going on breaks
· The expectations that direct care employees are attentive and ready to assist clients at all times when on duty
· Medical conditions and medical vulnerabilities of the elderly
· The dangers of heat and sun exposure for the elderly

The Respondent shall submit LIC500 with required staffing ratios to meet stipulation requirements.

The Respondent shall submit procedures on how direct care employees will monitor and document fifteen (15) minute checks when residents who have a diagnosis of dementia are outside in the courtyards of the facility.

If Respondents have successfully complied with the terms of this Stipulation, at the end of three (3) years from the effective date, the conditions imposed upon Respondents and Respondents’ license will expire and Respondents’ license shall be granted or restored in full. If Respondents have maintained compliance with the probationary terms and conditions of this Stipulation, at the end of twenty-four (24) months from the effective date of the stipulation, Respondents may petition the Department for a reduction in the three (3) year probation period. Such a reduction in the probationary period will be within the sole discretion of the Department.

Respondents agree that violation of any of the terms of probation or any of the other terms of this Stipulation shall constitute sufficient grounds to revocation of the probationary license granted herein.

A copy of this report, Stipulation and Waiver; and Order and Probationary License will be provided to the facility via Email and mailed to the Respondent. The report is to be signed and returned to LPA via Email.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn Avila	TELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2020

LIC809 (FAS) - (06/04)

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