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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045000603
Report Date: 05/21/2026
Date Signed: 05/21/2026 12:37:49 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
05/19/2026 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20260519114738
FACILITY NAME:MARBELLA OROVILLEFACILITY NUMBER:
045000603
ADMINISTRATOR:KALE, APRILFACILITY TYPE:
740
ADDRESS:400 EXECUTIVE PARKWAYTELEPHONE:
(530) 534-8160
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:88CENSUS: 39DATE:
05/21/2026
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:April Kale - Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident sustained hip fracture due to staff neglect. - SUBSTANTIATED
Staff did not notify responsible party of incident in a timely manner. - SUBSTANTIATED
INVESTIGATION FINDINGS:
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05/21/2026 10:20 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Executive Director April Kale. The purpose of this visit was to conduct a complaint investigation.

LPA interviewed the Executive Director and Memory Care Director during the visit. LPA obtained the following documents: Admission agreement, LIC602 Physicians report, care plan, related incident reports.

Continued on LIC9099-C

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

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
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 4
Control Number 59-AS-20260519114738
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: MARBELLA OROVILLE
FACILITY NUMBER: 045000603
VISIT DATE: 05/21/2026
NARRATIVE
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Resident sustained hip fracture due to staff neglect. – SUBSTANTIATED

It was reported that Resident 1 (R1) was found on the floor in the middle of the night. Staff reportedly picked R1 up and placed them back in bed.

LPA reviewed incident reports related to R1 being found on the floor after an unwitnessed fall in their room and R1 expressing pain and being transported via EMS to hospital the next morning. LPA reviewed LIC602 Physicians report which states that R1 has a diagnosis of age related dementia.

During interviews it was learned that Staff 1 (S1) found R1 on their floor on 03/15/2026 at 02:44 AM. Staff 2 was called to assess R1 and rather than call EMS to assess R1 for injury, which is the facility’s protocol, they chose to place R1 back in their bed. On the morning of 03/15/2026 at 09:20 AM during staff rounds that R1 expressed an extreme amount of pain. EMS was called immediately and R1 was transported to the local hospital where they were treated with emergency surgery for a fractured hip.

This allegation is substantiated. As a result of R1 suffering bodily injury and having to wait more than six hours in pain before EMS was called an immediate civil penalty in the amount of $500.00 is being issued this day and is documented on the attached LIC421IM.

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

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20260519114738
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: MARBELLA OROVILLE
FACILITY NUMBER: 045000603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/04/2026
Section Cited
CCR
87456(g)
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87465(g) Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by:
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The licensee agrees to conduct training with all staff on the requirement to call EMS to evaluate a resident after they have experienced an unwitnessed fall.
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Based on interviews S2 did not call EMS to evaluate R1 after a fall which resulted in R1 not being transported to the hospital until six hours after they fell in their room and suffered a fractured hip which required emergency surgery.
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Licensee agrees to submit the staff sign in sheet and training content to LPA as proof of correction.
An immediate civil penalty in the amount of $500 was issued as a result of this deficiency.
Type B
06/04/2026
Section Cited
CCR
87468.1(a)(8)
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87468.1 (a)(8) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8)To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by:
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The licensee agrees to conduct training with all staff on the requirement to call the responsible party when a resident experiences an unwitnessed fall.
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Based on interviews S2 did not inform R1s responsible party that R1 had experienced an unwitnessed fall.
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Licensee agrees to submit the staff sign in sheet and training content to LPA as proof of correction.
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: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20260519114738
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: MARBELLA OROVILLE
FACILITY NUMBER: 045000603
VISIT DATE: 05/21/2026
NARRATIVE
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Staff did not notify responsible party of incident in a timely manner. – SUBSTANTIATED

It was reported that the responsible party (RP) for Resident 1 (R1) was not notified that R1 had sustained a fall.

During interviews it was learned that on 03/15/2026 at 02:44 AM R1 was found on the floor of their room. Staff 2 (S2) informed their supervisor that they had not called to notify R1’s responsible party, a supervisor, or EMS that R1 had fallen.

This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegations are 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 April Kale.

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

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4