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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:21:28 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2022 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20221007091952
FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:FARMER, AMBERFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 32DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amber FarmerTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
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9
Call light system malfunctioning. Lights go off but audio alert is not working.
INVESTIGATION FINDINGS:
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5
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10
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12
13
LPA Hiratsuka, conducted the investigation into the allegations above. LPA wore a surgical mask during visit and observed all staff wearing surgical masks.

LPA Hiratsuka investigated the allegations: Call light system malfunctioning. Lights go off but audio alert is not working.

LPA interviewed multiple staff. Some stated it was working with no issues and some stated it was working but the switch was backwards. The ones who stated it wasn't working properly stated it was only for a very short time and there hasn't been any issues since. LPA cannot prove or disprove because there are several different version of events.

LPA cannot prove or disprove the allegation. The above is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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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