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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 557005053
Report Date: 06/10/2024
Date Signed: 06/13/2024 03:42:32 PM

Document Has Been Signed on 06/13/2024 03:42 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:COMMUNITY COMPASS, INC., THEFACILITY NUMBER:
557005053
ADMINISTRATOR/
DIRECTOR:		SKIDMORE, RICHARDFACILITY TYPE:
775
ADDRESS:19411 SUSAN WAYTELEPHONE:
(209) 588-1364
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 35CENSUS: 16DATE:
06/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Michelle Monahan- Assistant Program ManagerTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 6/10/23 at 10:30am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required one year annual visit. LPA Jensen met with Assistant Program Manager Michelle Monahan and explained the purpose of today's visit. The facility currently has a census of 16. There are 4 staff members and the Administrator who is present 2 days a week.

LPA Jensen toured the grounds. There are no bodies of water on the property. There are shaded areas available for outdoor activities. The facility maintains a garden with raised beds and bird feeders for use by clients. The window screens were observed to be in good repair. All paths were free of obstruction.

LPA Jensen toured the physical plant interior. The Day Program consists of a variety of activity rooms including a computer lab and music room as well as offices, bathrooms and a kitchen. The lighting and furnishings were observed to be adequate and in good repair. The facility was observed to be sanitary and free of odor. The thermostat was set to 70 degrees during the course of this inspection. The water temperature in the bathroom was tested and measured to be within the required range. Knives and medications were observed to be locked and inaccessible to residents in care. LPA Jensen observed a bottle of bleach and 3 bottles of isopropyl alcohol in a cabinet in the art room under the sink. The items were immediately removed and locked, technical assistance is being provided on storage of toxins. LPA Jensen observed 3 of 4 fire extinguishers were last serviced November 21, 2022. During the course of this visit, the Assistant Program Manager scheduled a service with the Fire Marshal for tomorrow, 6/11/24. LPA Jensen tested 2 smoke detectors and 2 of 2 were not functioning. 1 of 2 non-functioning smoke detectors were removed from the ceiling and stated on the back portion that attaches to the ceiling that it was manufactured in 2009 and should be replaced within 10 years. The first aid kit was determined to be complete. The facility conducts and logs emergency evacuation drills. The most recent evacuation drill was conducted in February of 2024 and is in compliance.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COMMUNITY COMPASS, INC., THE
FACILITY NUMBER: 557005053
VISIT DATE: 06/10/2024
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LPA Jensen reviewed 4 of 4 staff files and determined the files to be complete and in compliance. LPA Jensen reviewed 5 of 16 client files. 1 of 5 files contained an IPP that was not created within the last year. Technical assistance is being provided. 5 of 5 client files indicate that a staff to client ratio of 1:3 is required. LPA Jensen spoke to Administrator Richard Skidmore by telephone who confirmed that the facility is operating out of ratio however the facility is actively recruiting to fill a position. Technical assistance is being provided.

The facility maintains a large number of activities for client engagement. The facility also operates a "general store". The clients earn points by engaging in program activities and maintaining a positive attitude. The points earned through meaningful participation can then be used to purchase items from the store. Activities include exercise equipment, gardening, music, computer labs, various games and cooking classes. There were no clients present at the time of this inspection as they were all either at a job or on an outing. An interview was conducted with the Assistant Program Manager who was the sole staff member present.

LPA Jensen requested and received an LIC 500 and a current copy of the liability insurance.

Deficiencies are being cited pursuant to the California Code of Regulations (CCR) Title 22, Division 6. Civil penalties are also being assessed for fire clearance violations on this day.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2024 03:42 PM - It Cannot Be Edited


Created By: Maja Jensen On 06/10/2024 at 02:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COMMUNITY COMPASS, INC., THE
FACILITY NUMBER: 557005053

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82020
Fire Clearance
All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Jensen's observation of 3 of 4 fire extinguishers last serviced more than a year ago and LPA Jensen's testing of 2 smoke detectors which were non functional, the licensee did not take the necessary actions to maintain the fire clearance as required by the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
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The facility will replace all expired smoke detectors and have the Fire Marshal service the 3 of 4 fire extinguishers last serviced in November of 2022. In addition the Licensee will conduct and log monthly safety checks on all smoke detectors and carbon monoxide detectors. The Licensee will submit proof of correction to maja.jensen@dss.ca.gov.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
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