045001756-4-25-2024-59-AS-ABEN-D59TGS-20240514144334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001756
Report Date: 04/25/2024
Date Signed: 04/25/2024 11:17:48 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
02/05/2024 and conducted by Evaluator Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20240205092652

FACILITY NAME:	COMPASS ROSE		FACILITY NUMBER:	045001756
ADMINISTRATOR:	KEENE, CLIFF		FACILITY TYPE:	740
ADDRESS:	2750 SIERRA SUNRISE TERRACE		TELEPHONE:	(530) 774-2705
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	48	CENSUS: 26	DATE:	04/25/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Admin Pomali Thitphaneth		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident sustained a fracture while in care due to lack of care/supervision.
Staff mismanaged resident's medication.
A resident's personal rights were violated when staff did not prevent resident on resident intimidation, harassment, and/or harm.

INVESTIGATION FINDINGS:

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04/25/2024, Licensing Program Analyst Jaynae Boyles made an unannounced visit to the facility and met with administrator. The purpose of this visit was to deliver the results of a complaint investigation.
During the course of the investigation the administrator, and five staff were interviewed. LPA reviewed the following documents from the resident file: Physicians report (602), pre-appraisal, care assessment and needs and services plan for resident care. LPA reviewed incident reports, medical appointments, Medication Administration Record (MAR) and the physician orders while in placement at the facility.

Based on interviews, observation and record review of R1’s file the allegations are Unsubstantiated.
This agency has investigated the complaint alleging resident sustained a fracture while in care due to lack of care/supervision, staff mismanaged resident's medication, facility is unclean, a resident's personal rights were violated when staff did not prevent resident on resident intimidation, harassment, and/or harm.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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 3

Control Number 59-AS-20240205092652

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COMPASS ROSE	FACILITY NUMBER: 045001756
	VISIT DATE: 04/25/2024

NARRATIVE

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Resident sustained a fracture while in care due to lack of care/supervision.

Based on staff interview statements, R1’s facility assessment, physician’s report, and care plan, LPA determined the following information. R1 did have a fall that occurred on 11/24/2023, which resulted in a hip fracture. R1’s care plan, physician’s report, and resident assessment does not indicate that R1 is a fall risk. R1 is able to ambulate with minimal assistance per R1’s assessments and reports. R1 has not had any prior falls during R1’s residency at the facility. All staff statements obtained indicate that R1 had no issues ambulating. Staff statements indicate that there’s on average three to four staff working during the first and second shifts at the facility. Furthermore, the LPA reviewed the staff schedule during the time of the fall and there were three to four direct care support staff/med tech scheduled to work.

Staff mismanaged resident's medication.

On May 25, 2023, R1 was showing signs of disorientation and the resident was treated at the hospital for a UTI. The facility received the prescription and administered the medication as informed. On June 16, 2023, R1 was showing signs of disorientation and the facility informed the primary care physician and subsequently a urinalysis was ordered. On June 21, 2023 the results of the testing indicated that the test result was negative. On June 21, 2023 an order for antibiotics was placed by the primary care physician, the facility filled the prescription and administered the medication.

A resident's personal rights were violated when staff did not prevent resident on resident intimidation, harassment, and/or harm.

Based on staff interview statements, there has been no indication of R1 experiencing intimidation, harassment and/or harm from other residents in care. Based on review of the daily charting by staff there was no indication of R1 experiencing intimidation, harassment and/or harm from other residents in care. Based on a review of the incident reports, no such incidents have been reported to the Department regarding R1.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
02/05/2024 and conducted by Evaluator Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20240205092652

FACILITY NAME:	COMPASS ROSE		FACILITY NUMBER:	045001756
ADMINISTRATOR:	KEENE, CLIFF		FACILITY TYPE:	740
ADDRESS:	2750 SIERRA SUNRISE TERRACE		TELEPHONE:	(530) 774-2705
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	48	CENSUS: 26	DATE:	04/25/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Admin Pomali Thitphaneth		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility is unclean.

INVESTIGATION FINDINGS:

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04/25/2024, Licensing Program Analyst Jaynae Boyles made an unannounced visit to the facility and met with administrator. The purpose of this visit was to deliver the results of a complaint investigation.
During the course of the investigation the administrator, and five staff were interviewed. LPA reviewed the following documents from the resident file: Physicians report (602), pre-appraisal, care assessment and needs and services plan for resident care. LPA reviewed incident reports, medical appointments, Medication Administration Record (MAR) and the physician orders while in placement at the facility.

On February 05, 2024, the LPA toured the facility and found that it was safe, sanitary and in good repair.
This agency has investigated the complaint alleging facility is unclean. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted. A copy of the report was provided to administrator

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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 3