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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 08/28/2025
Date Signed: 08/28/2025 11:45:02 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250827102300
FACILITY NAME:MARBELLA OROVILLEFACILITY NUMBER:
045000603
ADMINISTRATOR:TIPPENS, JA LUISAFACILITY TYPE:
740
ADDRESS:400 EXECUTIVE PARKWAYTELEPHONE:
(530) 534-8160
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:88CENSUS: 43DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:April Kale - Executove DirectorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Physical plant violations.
INVESTIGATION FINDINGS:
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08/28/2025 09:30 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a complaint investigation. LPA met with Executive Director April Kale and explained the purpose of the visit.

During the visit LPA toured the facility and conducted interviews.

Continued on LIC9099-C

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 4
Control Number 59-AS-20250827102300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MARBELLA OROVILLE
FACILITY NUMBER: 045000603
VISIT DATE: 08/28/2025
NARRATIVE
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Physical plant violations- SUBSTANTIATED

It was reported that the facility wifi / internet has not been functioning since 08/11/2025. LPA confirmed this with the ED. ED stated that the company had changed IT vendors and the previous vendor shut down the internet services before the current provider had completed installation. During the period that the internet service has not been functioning the facility has placed hot spots for the residents to use to access the internet. These hot spots are secured using an authenticator to ensure privacy. Staff were using their personal hot spots until 08/27/2025 when the facility placed additional hot spots for the staff to use. The personal staff hot spots were also secured by the company authenticator to ensure security.

It was reported that the carpet in the memory care unit and assisted living common areas is stained and dirty. LPA observed the carpets memory care unit and assisted living common areas to be stained and dirty.

It was reported that the fence that surrounds the garden in the memory care unit is in disrepair. LPA observed multiple areas of the fence that have broken fence boards, areas where the fence is leaning, and large gaps at the bottom of the fence.

All of these physical plant violations are substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview conducted and a copy of the report was provided to Executive Director April Kale.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20250827102300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MARBELLA OROVILLE
FACILITY NUMBER: 045000603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2025
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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Licensee agrees to submit a plan to LPA with dates of the internet repair and or replacement, repair / replacement of garden fence, and cleaning / replacement plan for the carpet in the memory care unit and assisted living common areas.
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Based on LPA obervation and interviews the licensee failed to ensure that the facility internet remained operational during a vendor transition, the memory care garden fence is in disrepair, the carpet in the memory care unit and assisted living common areas is stained and dirty which poses a potential health and safety risk to residents in care.
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Licensee shall submit this plan to LPA by 09/04/2025. LPA will follow up with visits to the facility to ensure the repairs are completed by the due dates.
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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.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4