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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 05/30/2023
Date Signed: 05/30/2023 01:30:18 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, 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
02/28/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20230228144815
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: 30DATE:
05/30/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:AMBER FARMERTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are not ensuring residents are taken to doctor's appointments.
Unqualified staff are providing care to residents.
Staff do not have enough supplies for residents.
INVESTIGATION FINDINGS:
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Donna Gurriere, Licensing Program Analyst was in contact and met with Amber Farmer, Administrator.

Staff are not ensuring residents are taken to doctor's appointments.

During the interview process, the administrator, five staff persons, two residents, a nurse consultant and regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, staffing telephone numbers and staff training documents.



continued
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
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 7
Control Number 59-AS-20230228144815
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
VISIT DATE: 05/30/2023
NARRATIVE
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During the investigation process, it was indicated that a resident (Resident 1) was having difficulty with care to his infected feet. The resident’s feet appeared to have dry skin, were infected with what appeared to be yellow pus under several toenails and his feet were discolored. On 03/06/23 LPA Gurriere took photos of the resident’s feet which appeared to be in extremely poor condition.

On 03/03/23 the facility staff contacted emergency services in an effort to have the resident seek medical treatment at the hospital. When the resident arrived at the hospital, it was reported that the resident refused care and was sent back to the facility without treatment.

On 03/06/23, Donna Gurriere, Licensing Program Analyst met with the resident to discuss his medical treatment. LPA Gurriere asked the resident how he was doing with his feet and the resident stated that his feet were “Fine.” LPA Gurriere asked the resident if she could look at his feet and the resident allowed LPA Gurriere to see his feet.

The resident refused care at the hospital, the resident could not get into see his doctor until May 2023 and the resident was not opened to home health treatment or hospice care. The resident was not getting any care at the facility to assist in his infected feet and toes. On 03/08/23, it was reported by the administrator that the resident was opened to the hospice agency to address the resident’s infected feet.

Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 59-AS-20230228144815
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
VISIT DATE: 05/30/2023
NARRATIVE
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Unqualified staff are providing care to residents.

During the interview process, the administrator, five staff persons, two residents, a nurse consultant and regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, staffing telephone numbers and staff training documents.

During the investigation process, it was indicated that Resident 1 was having difficulty with care to his infected feet. The resident’s feet appeared to have dry skin, were infected with what appeared to be yellow pus under several toenails and his feet were discolored. On 03/06/23 LPA Gurriere took photos of the resident’s feet which appeared to be in extremely poor condition.

The licensee shall be permitted to accept or retain a resident who has a healing wound under the supervision of an appropriately skilled professional. The licensee has since hired a nurse consultant to assist in care for the residents; however, at the time of the incident, a nurse was not involved in the resident’s care; home health services and hospice care were not offered to assist with the resident’s infected feet either.

Staff were not qualified to know how to treat the resident’s feet, coupled with the fact that the resident was refusing treatment. On 03/08/23 the licensee was in contact with hospice services, and the hospice services opened up a contract with the resident.

Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20230228144815
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
VISIT DATE: 05/30/2023
NARRATIVE
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Staff do not have enough supplies for residents.

This allegation was substantiated and cited, refer to LIC 9099 dated 03/07/23.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
02/28/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20230228144815

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: DATE:
05/30/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:AMBER FARMERTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
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9
Staff are not providing adequate food service to residents.
Staff are not meeting residents diapering needs
INVESTIGATION FINDINGS:
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Donna Gurriere, Licensing Program Analyst was in contact and met with Amber Farmer, Administrator.

Staff are not providing adequate food service to residents.

During the interview process, the administrator, five staff persons, two residents, a nurse consultant and regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, staffing telephone numbers and staff training documents.

During the investigation process, it was stated by some staff that they felt that the meal portions were small and that the residents did not always get second servings if they were still hungry. However, overall, it was stated that the facility did have adequate food available to the residents.

continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20230228144815
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
VISIT DATE: 05/30/2023
NARRATIVE
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On 03/07/23 LPA Gurriere did a walk-through of the kitchen and noted that the facility had the appropriate food amount in perishables and nonperishable food. The facility had two types of juice available, cranberry, and strawberry, fresh vegetables, frozen items, dessert, sandwiches, cheese, and potatoes. The facility had several shelves of frozen food and nonperishable food. Food included soups, drinks, chicken, cranberries, bread, tater tots, rice, beans, and canned fruits. The menu was checked, and LPA Gurriere spoke with the cook. The cook is following the menu and the food was present for the cook to use.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Staff are not meeting residents diapering needs.

During the interview process, the administrator, five staff persons, one resident, a nurse consultant and regional center staff person were interviewed. Various documents were obtained and reviewed to include Physicians Reports, Admission Agreements, Appraisal and Needs, Medication Logs, staffing telephone numbers and staff training documents.

During the investigation process, it was indicated that a resident (Resident 2) was not being changed and diapered as needed. It was stated by some staff that the resident was not always toileted in a timely manner. However, overall, it was reported that the staff check on and change the resident at least every two hours. On 03/06/23 LPA Gurriere checked in on the resident and he had been recently changed and according to the care provider, she checked, and the resident was dry.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 59-AS-20230228144815
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: 05/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/31/2023
Section Cited
CCR
87464(d)
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Basic Services: A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs…
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The administrator agrees to develop a policy to ensure how this deficiency will be avoided in the future. Administrator shall submit to the licensing agency.
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This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee did not ensure that the resident received medical attention for his feet and toes. This poses an immediate health, safety, and personal rights risk to residents in care.
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Type A
05/31/2023
Section Cited
CCR
87631(a)(1)
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Healing Wounds: the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: When care is performed by or under the supervision of an appropriately skilled professional.
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This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee did not ensure that care for the resident was under the supervision of an appropriately skilled professional. This poses an immediate health, safety, and personal rights risk to residents in care.
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The administrator agrees to develop a policy to ensure how this deficiency will be avoided in the future. Administrator shall submit to the licensing agency.
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 CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7