045002773-10-28-2025-59-AS-LCRR-DPQUPM-20251226144544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 10/28/2025
Date Signed: 10/28/2025 12:25:29 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
10/20/2025 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20251020142705

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	BAXTER, STACEY		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(530) 538-8200
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS: 27	DATE:	10/28/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Stacey Baxter - Executive Director		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility is in disrepair - SUBSTANTIATED

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

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 5

Control Number 59-AS-20251020142705

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: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 10/28/2025

NARRATIVE

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Facility is in disrepair - SUBSTANTIATED

LPA inspected the laundry room during the visit and found the condition of the linoleum to be very bad. LPA observed cracked and missing pieces of linoleum which includes the areas around the floor drains which are in bad condition or have been patched. The licensee shall replace the linoleum in the laundry room.

LPA also observed two ceiling lighting ballasts that were not in working order, would not light up. Licensee shall replace the light bulbs and /or replace the ballasts as required to bring them to working order.

LPA inspected the upper floor food service area and observed that four cabinet drawers were missing and one cabinet door is missing. Licensee shall replace or repair the drawers and doors that are missing or damaged in this area.

LPA inspected 15 various resident rooms in the lower and upper areas of the facility.

LPA inspected closet / drawers in closets for disrepair and found all that were inspected to be in good repair.

LPA did not observe any resident room floors to be warped.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. An exit interview was conducted. A copy of the report was provided to executive director Stacey Baxter.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 59-AS-20251020142705

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: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/11/2025 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Licensee agrees to replace the linoleum in the laundry room, replace the light bulbs and / or replace the ballasts in the laundry room, replace or repair the drawers and doors that are missing or damaged in the upper food service area.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA observed the linolem in the laundry room is damaged / worn, two ceiling lighting ballasts in the laundry room that were not in working order, upper floor food service area observed that four cabinet drawers were missing and one cabinet door is missing.	8 9 10 11 12 13 14	Licensee shal submit photographs to LPA as proof of repair.
	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.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
10/20/2025 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20251020142705

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	BAXTER, STACEY		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(530) 538-8200
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS: 27	DATE:	10/28/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Stacey Baxter - Executive Director		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff does not ensure resident rooms have sufficient lighting. - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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10/28/2025 10:40 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a complaint investigation. LPA met with administrator Stacey Baxter and explained the purpose of the visit.

LPA interviewed the administrator, and toured the facility during the visit. LPA inspected fifteen (15) resident rooms for the quality of lighting and found that all rooms had ceiling fixtures that can be turned up or down to suit the resident and staff preference for brightness. LPA found the lighting to meet Title 22 requirements

Based on LPA observation the allegation is unfounded.
This agency has investigated the complaint alleging the lighting in resident rooms is not sufficient. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted. A copy of the report was provided to executive director Stacey Baxter.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

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

LIC9099 (FAS) - (06/04)

Page: 4 of 5