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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002440
Report Date: 11/06/2025
Date Signed: 11/06/2025 11:46:51 AM

Unsubstantiated


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
09/26/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250926083648
FACILITY NAME:COUNTRY CREST ASSISTED LIVINGFACILITY NUMBER:
045002440
ADMINISTRATOR:DAVIS, IRENEFACILITY TYPE:
740
ADDRESS:55 CONCORDIA LNTELEPHONE:
(530) 533-7857
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:95CENSUS: 59DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Irene David=s - mExecutive DirectorTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Staff do not ensure staff meet training requirements. - UNSUBSTANTIATED
Staff does not ensure resident's files are properly stored. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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11/06/2025 11:15 AM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with administrator Irene Davis. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA toured the facility, conducted interviews and reviewed documents.

Continued on LIC9099-C

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Rebecca Knight
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 2
Control Number 59-AS-20250926083648
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: COUNTRY CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 11/06/2025
NARRATIVE
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Staff do not ensure staff meet training requirements.-UNSUBSTANTIATED
It was reported that some caregivers do not have all the training hours to be working on the floor.
LPA observed a competency verification form that is filled out by the new employee in the first four days of employment as they complete each training and is verified by the Business office manager. This allegation is unsubstantiated.

Staff does not ensure resident's files are properly stored. - UNSUBSTANTIATED
It was reported that resident's files are not locked away in a cabinet.
On 09/28/2025 LPA toured the facility and observed the door to the business office to be locked, this ensured that resident and staff files are properly secured. This allegation is unsubstantiated.


Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted and a copy of the report was provided to Executive Director Irene Davis.
NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Rebecca Knight
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2