<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045001756
Report Date: 11/05/2020
Date Signed: 11/05/2020 12:17:45 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2020 and conducted by Evaluator Jaclyn Avila
COMPLAINT CONTROL NUMBER: 25-AS-20200505094805
FACILITY NAME:COMPASS ROSEFACILITY NUMBER:
045001756
ADMINISTRATOR:FREUDENDAHL, TRACYFACILITY TYPE:
740
ADDRESS:2750 SIERRA SUNRISE TERRACETELEPHONE:
(530) 894-5429
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:48CENSUS: 19DATE:
11/05/2020
ANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Cliff Keene, AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not administer medication as prescribe by physician
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/05/2020 at 00:00 AM/PM, Licensing Program Analyst (LPA) Jaclyn Avila conducted an announced complaint visit and met with Cliff Keen, Administrator. The purpose of the visit is to deliver complaint findings. Precautionary measures were taken regarding COVID 19. LPA arrived donned in PPE to include N95, Gown and Gloves. LPA and administrator remained outside the facility.

On 05/05/2020, California Department of Social Services community Care Licensing received a complaint alleging Staff did not administer medication as prescribed by the physician.

Staff interviews and a review of documents revealed staff administered Resident’s (R1) medication on 04/27/2020 at 1131 hours in addition to a PRN dosage given at 0522 hours and the routine dosage given at 0900 hours. A review of records revealed an “Order note” from the physician stating “My patient cannot determine his/her need for prescription medication but can clearly communicate his/her symptoms indicating a need for a PRN Medication. Must contact doctor before a PRN medication is given to patient.” Interviews revealed staff failed to follow this order to include the RSD and were administering the PRN medication without first contacting the physician.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020
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 2
Control Number 25-AS-20200505094805
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/05/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

It should be noted that during this investigation an additional complaint was made which alleged prescribed medications were given in an unsafe manner ref complaint #25-AS-20200606133857. This allegation was regarding the same incident and was also found to be substantiated. The department issued citations on 11/05/2020.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2