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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045001756
Report Date: 11/05/2020
Date Signed: 11/05/2020 12:23:15 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
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Cliff Keene, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff are not accurately recording on the medication logs
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 unannounced 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 are not accurately recording on the medication logs. Interviews and record reviews did not reveal inaccuracies.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
No citations issued on today’s date.
Unsubstantiated
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)
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