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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:44:18 PM

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
08/19/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240819142751
FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BINGHAM, DIANIAFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 35DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Stacey Baxter - administratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is in disrepair. – SUBSTANTIATED
Staff do not ensure that facility is clean. - SUBSTANTIATED
INVESTIGATION FINDINGS:
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11/14/2024 01:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Stacey Baxter. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA conducted staff interviews and reviewed the following documents: admission agreement, care plan, physician’s report, care notes, ADL charting, for 3 residents, housekeeping schedules, time sheets and assignment sheets,

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 7
Control Number 59-AS-20240819142751
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 11/14/2024
NARRATIVE
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Facility is in disrepair. – SUBSTANTIATED

It was alleged that the facility was in disrepair.

LPA visited the facility on 08/26/2024 and observed the following:



In the upper dining room LPA observed the section of wall under the breakfast bar had been patched but needed to be painted.

LPA observed the section of wall to the left of the hallway (decline) was missing the baseboard and this wall needed to be painted. In this decline hallway the linoleum baseboards needed to be cleaned.

LPA observed the baseboard outside of water heater closet was missing and the wall needs to be painted in addition to the hallway wall needs to be painted.

Based on LPA observation this allegation is substantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 59-AS-20240819142751
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 11/14/2024
NARRATIVE
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Staff do not ensure that facility is clean. – SUBSTANTIATED

It was alleged that the floors are dirty, the dining area had food on the floors and was very messy, a resident’s room was cluttered, had dirty floors, garbage can was full, bed was not made.

During a visit to the facility on 08/26/2024 LPA observed Resident 1's (R1) room was slightly cluttered but was not dirty. LPA observed the shower floor was very dirty. The trash can in the bathroom was not overflowing but did need to be emptied. In the upper dining room LPA observed that the floor had been swept, appeared to be clean yet dark and worn with normal wear and tear. However, LPA did observe significant dirt and grime on the floor next to the double doors.

LPA reviewed documents for three residents. The housekeeping weekly assignment sheet states that rooms 8B and 9B are cleaned every Tuesday, and room 17A is cleaned every Wednesday.

LPA reviewed housekeeping time sheets which show that there is one full time housekeeping staff. This staff person works 8-hour shift during the day, five days per week. On 08/14/2024 the facility hired a new housekeeper to replace the previous housekeeper.

Staff interviews revealed that staff sweep the floor, wipe tables, counters, and chairs after all residents have had their dinner. Resident room floors are mopped twice a week or as needed. Resident trash cans are emptied each shift.

Administrator stated We have the deep clean schedule (for each resident room) once a week. Light cleaning is completed by care staff who pick up newspapers, make beds. Staff tries to de-clutter the resident rooms but they have a delicate balance, resident rights, some love clutter. Trash cans are emptied every shift. Resident showers are cleaned weekly according to the house keeping schedule.

Based on LPA observation this allegation is substantiated. This allegation will be included in the physical plant citation.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegations are 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 administrator Stacey Baxter.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20240819142751
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2024
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 that will ensure that resident shower floors are cleaned immediately if they become soiled. Licensee agrees to clean the dirt and grime in the dining room floor next to the double doors. Licensee agrees to paint the breakfast bar wall, decline hallway walls, replace all missing baseboards, clean any dirty baseboards and will submit photographs to LPA as proof of correction.
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Based on LPA observation it was determined that the shower floor for 1 resident was very dirty. In the upper dining room LPA observed significant dirt and grime on the floor next to the double doors. In the upper dining room the section of wall under the breakfast bar had been patched but needed to be painted. In the decline to the left of the hallway the section of wall was missing the baseboard and this wall needed to be painted. In this decline hallway the linoleum baseboards needed to be cleaned. The baseboard outside of water heater closet was missing and the wall needs to be painted in addition hallway wall needs to be painted. This poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 11/28/2024.
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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: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
08/19/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240819142751

FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BINGHAM, DIANIAFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 35DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Stacey Baxter -administratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not respond to resident's call button in a timely manner.- UNSUBSTANTIATED
Staff does not ensure resident is provided clean linen in a timely manner. .- UNSUBSTANTIATED
Staff does not ensure facility is free of odor. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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11/14/2024 01:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Stacey Baxter. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA conducted staff interviews and reviewed the following documents: admission agreement, care plan, physician’s report, care notes, ADL charting, for 3 residents, housekeeping schedules, time sheets and assignment sheets,

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 59-AS-20240819142751
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 11/14/2024
NARRATIVE
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Staff do not respond to resident's call button in a timely manner. - UNSUBSTANTIATED

It was alleged that a visitor pulled a resident’s call light, waited 15 minutes and still no staff came to help.

LPA toured the facility on 08/26/2024, 09/05/2024, and 11/04/2024 and call bells were answered promptly during the visits.

All staff stated that response times are between 2 to 5 minutes but can be up to ten minutes if they are busy attending to another resident.

This allegation is unsubstantiated.

Staff does not ensure resident is provided clean linen in a timely manner. - UNSUBSTANTIATED

It was alleged that staff had removed a resident’s sheets in the morning and never came back. Staff said they are short staffed and didn't have sheets to fit the resident’s bed.

Staff interviews revealed that each client has two sets of their own sheets and additionally the facility has a large supply of sheets that can be used. Each resident has their sheets changed twice a week and as needed if soiled. Staff stated that once a resident’s sheets are sent to the laundry a new set is placed on the bed. If a resident’s bed is wet, staff have to let it dry before they can put on the new sheets.

Administrator stated New linen is put on with the shower schedule for each resident. Then we have the heavy soakers whose linen is to be changed daily. We always have extra sheets. It’s not just what the resident’s families bring, there is a house supply that they can make the bed from.

This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20240819142751
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: ROSELEAF OROVILLE
FACILITY NUMBER: 045002773
VISIT DATE: 11/14/2024
NARRATIVE
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Staff does not ensure facility is free of odor. - UNSUBSTANTIATED

It was alleged that the whole facility had a strong urine odor.

LPA toured the facility on 08/26/2024 and 09/05/2024 and did not notice a strong odor.

Staff could not recall the facility having a strong smell of urine.

Although the complainant experienced a strong smell of urine in the facility on their visit, LPA did not experience this on either day they toured the facility. 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.

An exit interview was conducted. A copy of the report was provided to administrator Stacey Baxter.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7