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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 01/15/2026
Date Signed: 01/15/2026 12:19:54 PM

Unsubstantiated


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
01/06/2026 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20260106130913
FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BAXTER, STACEYFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 24DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH: Editha McCulloug - administratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff does not prevent resident from physically abusing other residents.
INVESTIGATION FINDINGS:
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01/15/2026 09:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Editha McCullough. The purpose of this visit was to conduct a complaint investigation.

During the course of the investigation LPA toured the facility and conducted interviews.

Continued on LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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 2
Control Number 59-AS-20260106130913
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: 01/15/2026
NARRATIVE
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Staff does not prevent resident from physically abusing other residents. - UNSUBSTANTIATED

It was reported that Resident 1 (R1) physically abuses other residents.

During the course of the investigation it was learned that Resident 1 (R1) has a dementia diagnosis and lives in the memory care section of the facility. This behavior is new to R1 within the past 6 months and R1's physician is currently evaluating their medications to determine if a medication change is warranted. This behavior is mostly specific to Resident 2 (R2) who lives in the assisted living section of the facility and the behavior occurs at meal times. There was an incident where R2 sustained a cut to their arm when R1 grabbed them in the dining room. The facility has started keeping the memory care doors closed (unlocked) to help to deter the chance of the two residents interacting. Thus far this intervention has been successful. There have been a couple of other instances of behaviors from R1 toward other clients, there were no reported injuries as a result of these incidents.

It was determined that staffing was adequate during the incident when R2 sustained the cut to their arm.

This allegation is unsubstantiated.

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. No deficiencies cited. Exit interview conducted and a copy of the report was provided to administrator Editha McCullough.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
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