045002773-5-9-2023-25-AS-KHOS-CSCQS8-20230531122508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 05/09/2023
Date Signed: 05/09/2023 09:30:14 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220711103123

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	BROWN, TERRY L		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(530) 538-8200
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS:	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	AMBER FARMER		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Facility fire alarm system is in disrepair.

INVESTIGATION FINDINGS:

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On 07/15/22, Jaclyn Avila, LPA conducted a complaint investigation at the facility and listed one of the allegations as “Facility Fire Alarm System is in disrepair.” LPA Avila substantiated the allegation in the narrative of the report; however, did not give the facility a citation, as required.

LPA Avila stated in her report "In June of 2022, Roseleaf Oroville experienced the fire alarm system malfunctioning at which time they reached out to the vendor who inspected the system. The vendor recommended the system be replaced due to the system being antiquated and provided the invoice to the administrator who provided it to the Chief Operating Officer for the licensee. To date the system has not been replaced as recommended. Deputy Fire Marshal joined this department in a tour of the facility and strongly recommended the fire alarm system be replaced. Three egress lighting units did not function during the inspection on 7/15/2022 at 3:50 PM. These lights are instrumental in the event there is a power outage."

In an effort to amend the report, this document is being amended to reflect the required deficiency. Appeal Rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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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Control Number 25-AS-20220711103123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/10/2023 Section Cited CCR 87203	1 2 3 4 5 6 7	Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.	1 2 3 4 5 6 7	The administrator shall provide to the licensing agency with a current copy of a report that indicates that the fire alarm system is updated and in working condition. Civil Penalty is served this date.
	8 9 10 11 12 13 14	The licensee did not ensure that the Facility Fire Alarm System was in working condition. This is a zero tolerance violation and the facility shall be served a civil penalty this date.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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