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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 04/17/2025
Date Signed: 04/17/2025 10:32:52 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
02/25/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250225094703
FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BAXTER, STACEYFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 37DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jessica Owen - administrator in trainingTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Facility has an infestation of rodents.- SUBSTANTIATED
Facility call system is in disrepair. - SUBSTANTIATED
INVESTIGATION FINDINGS:
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04/16/2025 09:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator in training Jessica Owen. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the administrator, staff and a pest control technician. LPA requested the following documents: Staff schedules for the month of February 2025, resident assistant job description, and pest control invoices.

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

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 5
Control Number 59-AS-20250225094703
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: 04/17/2025
NARRATIVE
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Facility has an infestation of rodents. - SUBSTANTIATED

On 02/20/2025 LPA observed a small amount of mouse droppings in the closet of Room 12. On 04/13/2025 LPA toured the facility and found mouse droppings in the corner of a resident room that appeared to be dusty and dried up. LPA observed Clark non-toxic rodent monitors located inside of the facility and poison rodent traps located on the exterior of the facility.

LPA reviewed service invoices from Clark Pest Control dates 09/11/2023 through 03/17/2025. On these service invoices the technician made the following observations:

7/7/2023 Trees need to be trimmed back from the roof line - Pest and rodent entry into facility. Trim trees at least 4 feet back from structure. Screens Damaged, Missing or Improperly Fit -Pest and rodent entry into facility. Repair, Replace or Install screens.

08/07/2023 Door needs rodent proofing at bottom of door. Gaps/opening at bottom of door will allow pests and rodents into kitchen areas. Recommended action: Install new threshold, adjust door height, or install weather-proofing material.

Per pest control invoice dated 03/17/2025 these conditions / observations were still listed on the monthly service invoice. LPA interviewed Clark Pest control who confirmed that these conditions have not been mitigated by the facility.

Staff interviews confirmed that staff have observed rodents and/or their droppings in the facility.

It was determined that although the facility has monthly pest control services the issue with rodents still persists. There are recommendations that have been made by pest control that the facility has not implemented that may help to alleviate the rodent issue. The allegation is substantiated.

Continued on LIC9099-C

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

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20250225094703
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: 04/17/2025
NARRATIVE
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Facility call system is in disrepair. – SUBSTANTIATED

It was reported that call lights outside doors are inoperable to many resident rooms.

On 03/05/2025 LPA toured the facility and tested call lights that are located above resident rooms in the hallways in the lower hall. LPA observed that exterior lights above rooms 1,2,3,4,7, and 8 were not functioning, the lights were either very dim or did not light up at all.

It was determined that for some rooms the exterior call lights are either dim or not lighting up at all. This allegation is substantiated.

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: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
02/25/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250225094703

FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BAXTER, STACEYFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 37DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jessica Owen - administrator in trainingTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Facility does not have enough staff to meet the needs of residents in care. – UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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It was reported that care staff do laundry, deliver food and clean in addition to care duties.
LPA reviewed job description for care staff which includes the requirement to maintain a dean, odor-free, and well-maintained physical plant utilizing resources available in the community, and other duties as assigned by supervisor.
All staff interviewed stated that staffing was sufficient and there are no duties that are not being fulfilled.
It was determined that staffing is adequate and there are no duties that are not being completed. This allegation is unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted and a copy of the report was provided to administrator Stacey Baxter.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20250225094703
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: 04/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2025
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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The licensee shall implement and correct all observations made by pest control to help to prevent rodents from entering the facility to include: Trim back all trees 4 feet from roof line, ensure all screens have been replaced or repaired to ensure proper fit, inspect all exterior doors and repair all gaps/opening at bottom of doors to prevent rodents from entering the facility. Licensee shall submit a plan for all repairs with estimated dates of completion to LPA.
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Based on observation, document review and interviews it was determined that although the facility has monthly pest control services the issue with rodents still persists. This poses a potential Health, Safety and Personal Rights risk to residents in care.
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Licensee shall submit this plan to LPA by 05/01/2025. All repairs must be completed within 30 days. LPA will conduct a follow-up visit to ensure all items have been completed according to the plan as proof of correction.
Type B
05/01/2025
Section Cited
CCR
87303(1)(i)(c)
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87303(1)(i)(c) Maintenance and operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more … shall have a signal system which shall: (C) Identify the specific resident living unit. This requirement was not met as evidenced by:
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The licensee shall test all call lights from every resident room in the facility and observe the exterior light of each room. Licensee shall make a list with every room number and the current status of the exterior light (functioning properly, not working, dim). Once the list has been completed licensee shall repair every light that is not lighting correctly and add the date of repair to the list.
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Based on observation it was determined that six rooms in the lower hallway have exterior call lights that either do not light or are very dim when the call button is pushed in the resident room. This poses a potential Health, Safety and Personal Rights risk to clients in care.
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After all repairs have been completed licensee shall submit final list to LPA as proof of correction.
POC due date is 05/01/2025.
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: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5