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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 07/11/2025
Date Signed: 07/11/2025 02:07:39 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
07/01/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250701120437
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: DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ashlynn Kelley - administrative assistantTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Physical plant violations. - SUBSTANTIATED
INVESTIGATION FINDINGS:
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07/11/2025 12:30 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a complaint investigation. LPA met with Ashlynn Kelley - administrative assistant and explained the purpose of the visit.

LPA interviewed the administrative assistant, resident care coordinator and 6 staff during the visit. LPA requested copies of the following documents: MAR for 1 resident, housekeeping schedule, training logs for 1 staff, facility grocery orders for the month of June through July 2025, June and July 2025 menu, staff list with telephone numbers.

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

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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 4
Control Number 59-AS-20250701120437
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: 07/11/2025
NARRATIVE
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Physical plant violations. - SUBSTANTIATED

It was reported that licensee does not ensure that kitchen air conditioning is functioning properly. LPA visited the facility at 11:10 AM on 07/11/2025 and took multiple temperature readings in the kitchen. The average temperature reading was 97 degrees F.

It was reported that the licensee does not keep the resident rooms clean. LPA inspected three resident rooms. LPA found a large amount of dirt, dust, and debris under resident beds, under night stands and in corners of the rooms. The rooms were generally untidy and unclean. The facility requires more than one house keeping staff in order to ensure that all resident rooms are thoroughly cleaned on a regular basis.


Based on observation and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is 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 executive director Stacey Baxter.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20250701120437
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: 07/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2025
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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Licensee agrees to install a commercial air conditioning unit in the facility kitchen starting immediately and ending when the hot weather abates for the season. Licensee agrees to hire a second full time house keeping staff for a total of two full time house keeoing staff.
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LPA obserevd the kitchen temperatre to be 97 degrees F at 11:10 AM. LPA found a large amount of dirt, dust, and debris under resident beds, under night stands and in corners of the rooms. The rooms were generally untidy and unclean. This poses a potential health and safety risk to resident in care and staff working in the facility.
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The commercial air conditioning unit shall be installed by the end of day 07/11/2025. Licensee shall submit photograph of instaled unit and invocie for its purchase or rental.
Licensee shall hire a second full time housekeeper by 07/25/2025 and agrees to submit proof of hire and updated schedule to LPA as proof of correction.
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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: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4