045920148-1-8-2026-59-AS-LCRR-DQQTV9-20260127140335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045920148
Report Date: 01/08/2026
Date Signed: 01/08/2026 12:47:46 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-20260102152912

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:	DATE:	01/08/2026
		UNANNOUNCED	TIME BEGAN:	11:52 AM
MET WITH:			TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee does not ensure facility stove is in good repair. - SUBSTANTIATED

INVESTIGATION FINDINGS:

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01/06/2025 11:55 AM Licensing Program Analysts (LPA) Rebecca Knight arrived at the facility unannounced to conduct a complaint investigation. LPA met with house manager Lucas Watkins and explained the purpose of the visit.

LPA interviewed the house manager and toured the facility during the visit.

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

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 3

Control Number 59-AS-20260102152912

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/15/2026 Section Cited CCR 80087	1 2 3 4 5 6 7	80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to immediately replace the kitchen range with a new range that shall be installed by a licensed professional. The facility shall immediately cease using the faulty kitchen range and shall provide hot meals for all clients until the new range installation has been completed. If licensee requires a time extension on the POC due date theya are to contact LPA.
	8 9 10 11 12 13 14	Based on LPA inspection of kitchen stove it was determined that the stove is not functioning safely which poses a potential health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14	Licensee agrees to send LPA a photograph of the new installed range as proof or 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: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 59-AS-20260102152912

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: 01/08/2026

NARRATIVE

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Licensee does not ensure facility stove is in good repair. - SUBSTANTIATED

It was reported that the range in the facility kitchen is malfunctioning. The control face of the range shows warning lights that say the cook top is on when it is not on. Often staff have to turn off the kitchen circuit breaker in order to turn off the oven since the oven will not turn off when the off button is pushed.

When LPA arrived staff were cooking lunch using the oven, LPA observed red warning lights lit on the range face that said "Cook top On" and "Cook top Hot. The cook top was not being utilized by staff at this time.

The allegation is substantiated.

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 administrator Jessie Boothe.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC9099 (FAS) - (06/04)

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