045002440-7-30-2026-59-AS-LMUZ-DWQQHN-20260807121124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002440
Report Date: 07/30/2026
Date Signed: 07/30/2026 09:58:54 AM

Unfounded

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
07/21/2026 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20260721155220

FACILITY NAME:	COUNTRY CREST ASSISTED LIVING		FACILITY NUMBER:	045002440
ADMINISTRATOR:	DAVIS, IRENE		FACILITY TYPE:	740
ADDRESS:	55 CONCORDIA LN		TELEPHONE:	(530) 533-7857
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	95	CENSUS: 59	DATE:	07/30/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Irene Davis - Executive Director		TIME COMPLETED:	09:20 AM

ALLEGATION(S):

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Lack of staff supervision resulting in resident sustaining fracture. - UNFOUNDED
Staff did not respond to resident's call light in a timely manner. - UNFOUNDED
Staff did not report incident to responsible party. - UNFOUNDED

INVESTIGATION FINDINGS:

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07/30/2026 09:10 AM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with Executive Director Irene Davis. The purpose of this visit was to deliver the results of a complaint investigation.

During interviews it was learned that the resident that the complaint concerns has never lived at the facility. This complaint is unfounded.

This agency has investigated the complaint alleging a personal rights violation. We have found the complaint was UNFOUNDED, meaning that the allegations qre false, could not have happened, and/or is without a reasonable basis.

No deficiencies cited. Exit interview conducted and a copy of the report was provided to Executive Director Irene Davis

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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