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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002773
Report Date: 02/20/2025
Date Signed: 02/20/2025 01:48:16 PM

Document Has Been Signed on 02/20/2025 01:48 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 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: 33DATE:
02/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Stacey Baxter - administratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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02/20/2025 1:20 PM During a visit to the facility Licensing Program Analysts Rebecca Knight and Kayla Adkison were approached by Resident 1 (R1) who reported mice droppings in the closet of their room.

LPAs asked R1 if they could inspect their closet. R1 gave LPAs permission and allowed LPAs entry to their room. LPA Knight observed a small amount of mice droppings in the closet.

Administrator stated R1 does not ever allow housekeeping into their room to complete deep cleaning.

LPAs asked R1 if they would allow housekeeping into their room to clean during the visit. R1 agreed to this. LPAs witnessed housekeeping Staff 1 (S1) at the entry to R1's door. S1 stated that R1 is allowing them in to clean the room that day.

LPA Knight will return for a follow-up visit to ensure R1's room has been deep cleaned. Administrator will submit requested documentation of refusals of the times that R1 has refused housekeeping staff entry to clean their room in the past.

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: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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