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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001756
Report Date: 03/09/2022
Date Signed: 03/09/2022 03:36:59 PM


Document Has Been Signed on 03/09/2022 03:36 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: 24DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cliff Keene, Administrator TIME COMPLETED:
12:00 PM
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On 03/09/2022 at 10:00 AM, Licensing Program Analyst (LPA) Jaclyn Avila and Licensing Program Manager (LPM) Laura Munoz arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA and LPM met with administrator Cliff Keene and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA Avila and LPM Munoz was screened by care staff upon entrance to the facility.

LPA Avila, LPM Munoz and Mr. Keene, toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, hallways, resident bedrooms, kitchen and the courtyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Avila, LPM Munoz and the administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report was given to administrator Cliff Keene.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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