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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002773
Report Date: 01/08/2025
Date Signed: 01/08/2025 10:35:36 AM

Document Has Been Signed on 01/08/2025 10:35 AM - 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR/
DIRECTOR:		BAXTER, STACEYFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY: 60CENSUS: 32DATE:
01/08/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Stacey Baxter - administratorTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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01/08/2024 10:00 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with administrator Stacey Baxter. Today’s visit is regarding incident reports that have been submitted by the facility regarding several falls that recently occurred at the facility specifically involving residents who are on hospice The purpose of the visit was for LPA to have a discussion and provide resources.

Administrator stated hospice residents are being re-evaluated for change of condition and suitability for hospice placement.

In order to prevent this from occurring the facility will conduct a fall prevention training with all staff. Facility will update fall prevention plan to include staff rounds every 30 minutes (will be documented) and administrator will conduct hourly rounds to ensure that residents are monitored for safety. Administrator will submit a copy of the facility’s updated fall prevention plan to LPA.

LPA referred administrator to ​​​​​​​​​Stop Falls Sacramento Coalition for additional resources in fall prevention.

https://dhs.saccounty.gov/PUB/StopFallsSacramento/Pages/Stop-Falls-Sacramento-Coalition.aspx

No deficiencies were issued as a result of today’s visit. A copy of the report was provided to administrator Stacey Baxter.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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