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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045920038
Report Date: 12/11/2025
Date Signed: 12/11/2025 03:13:59 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
12/01/2025 and conducted by Evaluator Kayla Adkison
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20251201110236
FACILITY NAME:COUNTRY HOUSEFACILITY NUMBER:
045920038
ADMINISTRATOR:FOZ, MICHAELFACILITY TYPE:
740
ADDRESS:966 KOVAK CTTELEPHONE:
(530) 342-7002
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:20CENSUS: DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:MIchael Foz, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Uncleared adult is supervising residents
INVESTIGATION FINDINGS:
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On December 11, 2025, Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility for the purpose of delivering findings for a complaint that was received December 1, 2025. LPA was greeted by Administrator Michael Foz and explained the purpose of the visit.

During the course of the investigation, LPA reviewed pertinent documents and conducted interviews with staff.

Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 3
Control Number 59-AS-20251201110236
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: COUNTRY HOUSE
FACILITY NUMBER: 045920038
VISIT DATE: 12/11/2025
NARRATIVE
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Allegation: Uncleared adult is supervising residents

It was alleged that a staff member (S1) was providing care and supervision to the residents of the facility without a criminal record clearance. Only S1’s first name, approximate age, and physical features were provided in the complaint summary.

On December 1, 2025, LPA reviewed the California Department of Social Services Guardian Background Check System and observed a staff with the same first name and approximate birth date who had been associated to the facility on December 1, 2025. LPA noted this staff had received a criminal record exemption on November 7, 2025.

LPA contacted the facility Administrator via email and requested a current LIC 500 – Staff Roster. LPA reviewed the current LIC 500 and observed a staff member with the same first name whose start date was listed as December 1, 2025.

LPA interviewed Administrator who stated S1 was the only staff member in the facility with the same first name listed in the complaint. Administrator stated S1 had been employed by the facility on and off for several years and was most recently working in October and November 2025 before going on a temporary leave of absence.

LPA interviewed Licensee, Rico Foz, who admitted he hired S1 knowing they had not yet received a criminal record clearance/exemption to be able to work in the facility. Licensee stated he was trying to help S1 when they were in need.

Administrator stated S1 is still currently employed by the facility, however, is not on the schedule at this time.

On December 7, 2025, LPA reviewed the staff schedule for the months of October and November and noted S1 was listed as working for 19 days between October 3, 2025, and November 7, 2025, when S1’s criminal record exemption was approved.

Based on observations, document review, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is cited on the attached LIC 9099-D. Civil Penalties have been assessed on the attached LIC421BG. Exit Interview conducted. A copy of this report, and Appeal Rights were provided to Michael Foz, Administrator, via email.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20251201110236
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: COUNTRY HOUSE
FACILITY NUMBER: 045920038
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2025
Section Cited
CCR
87411(g)(1)
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87411 Personnel Requirements - General
(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations.
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Administrator agrees to fill out a LIC 9098 Proof of Correction Form indicating the regulation is understood for the future. Further, civil penalties have been assesed. Adminsistrator shall provide LIC 9098 to LPA by end of business on December 12, 2025.
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This is evidenced by:
Based on interviews conducted, observation, and documentation reviewed, the Licensee did not ensure that S1 had a valid criminal record clearance before working in the facility, which posed an immediate health and safety risk to residents in care.
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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: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3