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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 557005053
Report Date: 09/13/2024
Date Signed: 09/13/2024 02:12:46 PM

Document Has Been Signed on 09/13/2024 02:12 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: 19DATE:
09/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Michelle Monahan and Renee Tang (by telephone)TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 9/13/24 at 11:00am Licensing Program Analyst (LPA) Maja Jensen arrived at the facility unannounced to conduct a case management regarding a change in ownership. LPA Jensen met with Program Director Michelle Monahan and explained the purpose of today's visit.

The Department was notified by the Regional Center that the Licensee was selling the business and provided the Department with a letter stating such dated August 6, 2024. It was verified that a application for licensure is pending with the Centralized Application Bureau. The Program Director advised that the Program has a new owner which is staff 1 (S1) and a new Administrator (A1). No notice was received by the Department that a change in Administrator has been implemented. LPA Jensen reviewed the rental agreement and verified that Licensee Richard Skidmore currently has control of property.

The Program Director verified that staff working at the facility today include , herself, S1, staff 2 (S2), staff 3 (S3), and staff 4 (S4). LPA Jensen reviewed a staff schedule which lists the Program Director and staff 2 through 5 as well as an additional staff member, staff 6 (S6). The Program Director advised S6 is on vacation and that S1 is covering the shift for S6. LPA Jensen verified in Guardian that S1 has not been granted a finger print clearance but rather that clearance is "in process". LPA Jensen also verified in Guardian that S6 has not been associated to this facility. An LIC 9182 is being provided so that the Program Director can request the transfer for S6. The Program Director was advised that S1 may not be present at the facility until and unless they have been granted fingerprint clearance. Technical assistance is being provided on reporting requirements and accountability of the Licensee. LPA Jensen is requesting that an LIC 500, LIC 308, LIC 200 and evidence of Administrator qualifications to be provided by close of business 9/16/24.

Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6. Civil penalties are also being assessed. An exit interview with the Program Director and A1 (by telephone) was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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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Document Has Been Signed on 09/13/2024 02:12 PM - It Cannot Be Edited


Created By: Maja Jensen On 09/13/2024 at 01:14 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: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2024
Section Cited
CCR
82065(i)

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Prior to employment or initial presence in the day program, all employees and volunteers subject to a criminal record review shall:
(1) Obtain a California clearance or a criminal record exemption ...
(2) Request a transfer of a criminal record clearance...
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A signed attestation will be sent by the Administrator stating that S1 will not be present at the facility until they have a criminal background clearance or exemption is granted. The Program Director will complete the LIC 9182 on this day and send to the Department for transfer.
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This requirement was not as evidenced by LPA Jensen's interview with staff and record review, S1 and S6 have been working or present at the facility. It was verified that S1 lacks a criminal background clearance and S6 lacks a criminal record clearance transfer. This poses an immediate risk to the health, safety and personal rights of clients in care.
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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: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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