045002773-1-6-2026-59-AS-LCRR-DRPPNN-20260227102810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002773
Report Date: 01/06/2026
Date Signed: 01/06/2026 01:08:16 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
01/02/2026 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20260102150659

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: 25	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	11:39 AM
MET WITH:	Ashlynn Keley - administrative assistant		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident room has roof leak and electrical outlet is sparking. - SUBSTANTIATED

INVESTIGATION FINDINGS:

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01/05/2026 11:40 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to open a complaint investigation. LPA met with administrative assistant Ashynn Kelley and explained the purpose of the visit. Executive Director (ED) Stacey Baxter was unavailable for the visit.

During the investigation LPA toured the facility and conducted interviews.

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 59-AS-20260102150659

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: 01/06/2026

NARRATIVE

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Resident room has roof leak and electrical outlet is sparking. - SUBSTANTIATED

LPA inspected Room 2 and found that there was a water leak in the ceiling on the north-west corner. LPA witnessed buckling paint on the interior wall. LPA viewed the exterior wall of the room (which is in a corner of the building) and determined that a leak was present in the corner.

The allegation that the ceiling in a resident room has a leak is substantiated. LPA did not witness sparks coming from electrical outlets in the room and could not substantiate this portion of the allegation.

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. Exit interview conducted and 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: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20260102150659

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: 01/06/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/20/2026 Section Cited CCR 87303	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 have the ceiling and walls inspected in Room 2 for leaks and will also ensure that all electrical outlets are functioning safely and have not bee affected by the leak.Licensee agrres tom complete all necessary repairs.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA inspected Room 2 and found that there was a water leak in the ceiling on the north-west corner. LPA witnessed buckling paint on the interior wall. LPA viewed the exterior wall of the room (which is in a corner of the building and determined that a leak was present in the corner. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Licensee shall send invoices from the contractor to LPA as proof of correction.
	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: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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