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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001756
Report Date: 07/06/2022
Date Signed: 07/06/2022 02:37:19 PM


Document Has Been Signed on 07/06/2022 02:37 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:COMPASS ROSEFACILITY NUMBER:
045001756
ADMINISTRATOR:KEENE, CLIFFFACILITY TYPE:
740
ADDRESS:2750 SIERRA SUNRISE TERRACETELEPHONE:
(530) 774-2705
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:48CENSUS: 28DATE:
07/06/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Cliff KeeneTIME COMPLETED:
03:00 PM
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On 07/06/2022 at 1:00 PM, Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility and met with Administrator Cliff Keene and Resident Services Director (RSD) Pomali Thitphaneth to conduct a case management visit. The purpose of today's visit was to ensure compliance with the terms and conditions set forth in the Stipulation and Waiver; and Order effective June 29th, 2020.

LPA toured the facility with Administrator and RSD. LPA inspected the common areas, kitchen, dining room, memory care unit and courtyard. LPA observed that per the stipulation order and staff schedules. LPA obtained copies of the April, May and June staff schedules and observed that the facility is staffing the facility with the minimum requirements to meet the needs of the residents in care.

LPA reviewed the training documents and observed that the facility has provided the required training.

LPA reviewed logs documenting that clients are checked on every 15 minutes in the courtyards at the facility.

The facility has also informed current and prospective residents that it is currently operating under a probationary license. The terms of the probation are posted in the facility.

LPA requested facility conduct an audit of resident's LIC 602's (physicians reports) to see which residents that personal hygiene items would pose a risk to.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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