045920148-7-24-2025-59-AS-KHOS-DK4K4L-20250731073430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045920148
Report Date: 07/24/2025
Date Signed: 07/24/2025 11:41:54 AM

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
07/21/2025 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20250721121340

FACILITY NAME:	GOLD CITY ARF		FACILITY NUMBER:	045920148
ADMINISTRATOR:	BOOTHE, JESSIE		FACILITY TYPE:	735
ADDRESS:	980 HIGH STREET		TELEPHONE:	(530) 888-5000
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	6	CENSUS: 6	DATE:	07/24/2025
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Jessie Boothe - administrator		TIME COMPLETED:	11:50 PM

ALLEGATION(S):

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Facility is not equipped with hand hygiene supplies for staff and clients' use. - UNSUBSTANTIATED
Facility does not have adequate supply of pots and pans. - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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07/24/2025 10:05 AM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with staff Maya Merrifield and spoke with administrator Jessie Boothe on the phone. LPA explained the the purpose of the visit was to conduct a complaint investigation.

LPA interviewed the administrator over the phone and 1 staff at the facility during the visit.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

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-20250721121340

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: GOLD CITY ARF	FACILITY NUMBER: 045920148
	VISIT DATE: 07/24/2025

NARRATIVE

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Facility is not equipped with hand hygiene supplies for staff and clients' use. - UNSUBSTANTIATED

LPA toured the facility and inspected the kitchen sink and two bathroom sinks. LPA observed soap at the kitchen sink and in one bathroom. One bathroom did not have hand soap available on the counter. Staff immediately placed an unopen hand soap in this bathroom and placed a bottle of hand sanitizer in both bathrooms. LPA observed supply cabinet that contained extra hand soap and hand sanitizer. Staff confirmed that all staff have the key available to them and can access all supplies. There were no paper towels located in either bathroom or the kitchen sink.

Staff stated that they just ran out of paper towels on 07/23/2025. Administrator stated that the facility placed an order for paper towels a week ago but Amazon has not yet delivered them. Administrator stated they will send a supply of paper towels to the facility by noon today. Paper towels were deliverd to the facility during the visit at 11:30 AM. No deficiencies.

Facility does not have adequate supply of pots and pans. - UNSUBSTANTIATED

LPA inspected supply of pots and pans and observed two sauce pans, three frying pans, 1 skillet, four cookie sheets, two Pyrex baking dishes, 1 very large pot, one large pot, and various other utensils, and cooking apparatus. No deficiencies.

This agency has investigated the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted and a copy of the report was provided to administrator Jessie Boothe.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

LIC9099 (FAS) - (06/04)

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