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    Roseleaf Oroville

    1900 20th St, Oroville, CA, 95965
    4.0 · 41 reviews
    • Assisted living
    • Memory care
    For pricing and availability(510) 508-4507
    For the front desk(530) 538-8200
    AnonymousLoved one of resident
    2.0

    Beautiful facility but unsafe care

    I placed my loved one here and had a very mixed experience. The building and grounds are beautiful - big backyard, fruit trees and updated cottages - and several caregivers and managers were caring, professional, and went the extra mile. But chronic understaffing, inconsistent and sometimes rude or neglectful staff, declining cleanliness and poor oversight created unsafe situations (resident aggression, missed care, injuries). Given the management turnover and quality decline, I would only recommend this place after very careful vetting - otherwise I do not recommend.

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    Amenities

    4.02 · 41 reviews

    Overall rating

    1. 5
    2. 4
    3. 3
    4. 2
    5. 1

    • Care

      3.4

    • Staff

      3.8

    • Meals

      4.0

    • Amenities

      2.8

    • Value

      2.7

    Location

    Map showing location of Roseleaf Oroville

    About Roseleaf Oroville

    Roseleaf Oroville offers a safe, comfortable place for seniors who need skilled nursing, memory care, or assisted living, and you see right away that the grounds feel inviting, with secure walking paths, outdoor gardens, and private or semi-private rooms, as well as the standalone bungalows that give a bit more privacy when needed, and they do let you bring pets under certain guidelines, while guests can come for mealtime which brings a nice touch of home, and with a full range of services like medication management, laundry, and personalized care plans, residents can get help with things like bathing or dressing from a team that's there around the clock and knows what each person needs. Meals are cooked by chefs who pay attention to special diets and a registered dietitian helps with the menus, so residents get nutritious food, plus snacks, and if someone wants to stay in their room or needs room service, that's available too. They have state-of-the-art equipment and spaces for both rehabilitation and daily physical therapy work, and on-site haircuts or barber services make it easy to keep up with grooming. There's a full schedule of life enrichment activities, like music, events, and recreational programs, aiming to keep everyone social and active, and outings and community events help fight isolation and keep people connected. The community is set up so assisted living and memory care areas stay separate, letting staff focus better on each group's needs, and the memory care is tailored for people with Alzheimer's or dementia, with special support and secure spaces. For families who need a break, respite care is offered, and when needed, hospice and palliative services support comfort and pain relief. Residents can use the coffee area, cozy library, lounge, and game room, and transportation for outings or appointments is part of what they provide. The all-inclusive pricing takes some of the guesswork out for families, and because Roseleaf Oroville is licensed by the State, people can feel more confident about oversight and care standards. The goal throughout seems to be making sure everyone feels at home, valued, and helped in the ways that mean the most to them, which you can see in the details of their daily routines, staff training, and the simple ease of daily living here.

    People often ask...

    State of California Inspection Reports

    119

    Inspections

    38

    Type A Citations

    18

    Type B Citations

    6

    Years of reports

    21 May 2025
    Investigated a report that a staff member verbally abused two residents, shoved one resident's wheelchair into the hall causing it to roll toward the wall, and walked past without acknowledging them.
    • § 9058
    21 May 2025
    Found that the issues described in the complaint—trees trimmed away from the roof line, screens intact, and exterior doors with thresholds or weather stripping—were in proper condition.
    • § 9058
    01 May 2025
    Found two insulin-related allegations—one said a staff member gave a resident insulin, and another claimed insulin was given without glucose checks. Evidence did not prove these actions occurred.
    17 Apr 2025
    Identified rodent infestation with droppings and unmitigated pest control issues at the site, and found call lights outside several rooms to be inoperable or very dim. The staffing allegation that care staff performed laundry, delivered meals, and cleaned in addition to care duties lacked sufficient evidence.
    • § 87303(1)(i)
    • § 87303(a)
    20 Feb 2025
    Identified a resident’s report of mice droppings in their closet; observed a small amount of droppings and confirmed housekeeping was allowed to enter to clean.
    20 Feb 2025
    Identified deficiencies including two staff files missing first aid certificates, a non-draining sink in the lower activities room bathroom, a soiled shower floor in Room 9, a missing glass cover and a dirty fan in Room 26 bathroom, discarded items at the west entrance, discarded rental equipment in the sun room, two exterior window screens needing reinstallation, weeds in gutters over the entrance to the activity room, a discarded metal table in the backyard, and heavy metal doors at the east side activity area. Observed that medications were secured, fire extinguishers were charged, smoke detectors were operational, disaster drills were conducted, and food supplies were adequate, with staff and resident files reviewed.
    • § 1569.618(c)(3)
    • § 87303(a)
    04 Feb 2025
    Found thermostats set at 78 degrees and six resident rooms measured 74 to 79 degrees; the temperature-related allegation UNSUBSTANTIATED.
    08 Jan 2025
    Investigated falls involving hospice residents; no deficiencies were issued.
    17 Dec 2024
    Investigated the allegation about room temperatures in the lower hall; temperatures there were below required levels, while ten random rooms in the middle and upper halls measured 72–79 degrees, meeting requirements; residents had been moved from the lower area in November 2024, and no deficiencies were found.
    25 Nov 2024
    Found that the complaint about keeping temperatures comfortable was supported by readings, with lower hall temperatures at 62 degrees and some resident rooms below the 68-degree minimum. Found that the allegation that the HVAC unit was not in good repair could not be established.
    • § 87303(b)
    14 Nov 2024
    Ordered immediate exclusion for a staff member from all licensed facilities, prohibiting work, presence, or contact with clients. Administrator confirmed the staff member is not currently employed or present.
    14 Nov 2024
    Identified a shortage of laundry detergent that caused laundry to pile up in the laundry room. Other concerns—falls, continence care, wound care, medication swallowing, nighttime snacks, and clean dishes—did not prove violations.
    • § 87303(g)(1)
    14 Nov 2024
    Identified disrepair at the site, including patched walls needing paint and missing baseboards. Found cleanliness concerns in some areas, with dirty floors and clutter in a resident’s room, but call bells were answered promptly, clean linen was provided, and no strong urine odor was observed.
    • § 87303(a)
    18 Jun 2024
    Investigated allegations found that a resident was fed and ate meals. Levothyroxine was not administered as ordered, resulting in hospitalization for severe hypothyroidism; other concerns about wound care, laundry, and temperature control were not supported by evidence.
    18 Jun 2024
    Identified that staff failed to administer a resident's medication, leading to the resident's hospitalization for severe hypothyroidism, with penalties imposed for repeated violations. Found that allegations of not feeding the resident, inadequate wound care, laundry issues, and temperature comfort were unsubstantiated.
    • § 87465(a)(4)
    16 May 2024
    Found no evidence to prove the allegation that staff did not meet a resident’s incontinence needs related to condom catheter use. Although staff assisted with a condom catheter, its use was not included in the resident’s care plan.
    16 May 2024
    Investigated the allegation that staff failed to assist a resident with condom catheter issues, found that staff did provide assistance despite the catheter not being included in the resident’s care plan, and concluded there was insufficient evidence to prove a violation occurred.
    09 May 2024
    Investigated an incident in which a resident became agitated after another resident was in their room, and staff escorted the agitated resident out safely and prevented re-entry. The resident was transported to a hospital and later released with medication changes; one staff member was terminated; no injuries occurred; no deficiencies were cited.
    09 May 2024
    Investigated an incident where staff guided a resident out of another resident’s room after the resident became agitated and combative, resulting in hospital transport and medication adjustments, with no injuries reported.
    02 May 2024
    Found safety lapses in transport and bathing: a wheelchair-bound resident fell when not secured with a seat belt during a van ride, and another resident was not bathed as required by their care plan. Creams for a rash were applied as prescribed, hydration needs were met, and there was no scrape.
    02 May 2024
    Identified that staff failed to ensure a non-ambulatory resident was properly secured with a seatbelt during transportation and that a resident was not bathed as scheduled, while finding that the resident's injury was not due to neglect, water was appropriately offered to residents, and staff applied necessary skin treatments correctly.
    • § 87468.2(a)(4)
    • § 1569.2(c)
    23 Apr 2024
    Identified the allegation that a resident did not receive prescribed medications because they ran out of multiple medications; missed doses occurred from February through March 2024. Interviews and MAR reviews supported this finding.
    • § 87465(a)(4)
    23 Apr 2024
    Identified that a staff member yelled at a resident and was terminated. Determined no medication error occurred for Resident 1, while a prior medication error involving Resident 3 had been reported.
    23 Apr 2024
    Identified that the resident’s emergency packet and identifying information were not provided to EMS, leaving unknown code status and medical history. Found that staff were trained on emergency procedures, and the issue occurred because the resident’s records were not accessible at the time.
    • § 87506(a)
    23 Apr 2024
    Investigated reports of staff yelling at residents and found that staff member was terminated for this behavior; also reviewed medication administration but determined no medication error occurred concerning two residents.
    • § 87468.1(a)(1)
    19 Mar 2024
    Found safety and care measures generally in place, with several maintenance and training deficiencies identified. Noted expired first aid certificates for some staff, damaged outdoor furniture, missing window screens in the medication room, a refrigerator that needs defrosting, and weeds around gutters.
    • § 1569.618(c)(3)
    • § 87303(a)
    19 Mar 2024
    Found that a staff member gave another resident’s medication to a different resident, leading to hospitalization for observation; the error occurred because there was no photograph on file to verify the resident’s identity and the staff member did not follow the photo verification step of the Six Rights.
    19 Mar 2024
    Confirmed that staff improperly managed medication by dispensing it to the wrong resident without verifying their identity, leading to a resident being hospitalized after a medication error.
    • § 87465(a)(4)
    14 Mar 2024
    Identified disrepair, including leaks from shower hoses in three rooms, a laundry room door hinge that prevents closing, and non-working laundry equipment in the second laundry room; floors in resident rooms were clean. Two other issues require further review and will be covered in a separate report.
    14 Mar 2024
    Found that the floors were kept in clean and safe condition, but the facility was in disrepair, with broken and leaking shower hoses and a door hinge issue affecting laundry room access.
    • § 87303
    07 Mar 2024
    Investigated allegation that the facility failed to provide documents to the responsible party; findings UNSUBSTANTIATED.
    07 Mar 2024
    Reviewed a complaint about the responsible party’s request for resident records, finding that the facility sent the records as requested and that the resident’s medical records were not maintained by the facility.
    08 Nov 2023
    Found no evidence of a leak in the toilet in Room 9; the allegation claimed it leaked on 11/05/2023 and was reportedly fixed on 11/06/2023.
    08 Nov 2023
    Investigated the allegation that the toilet in Room 9 was leaking and found no evidence of a leak or water on the floor after repairs had been completed. The allegation was not supported by the findings.
    01 Nov 2023
    Investigated findings showed that one resident could not reach their call button because the cord was missing and the setup required the bed to be against the wall. Other reported concerns—shower timing, meal delivery, wound care, and adherence to a special diet—lacked sufficient evidence.
    01 Nov 2023
    Investigated concerns included a broken call light lacking a cord preventing a resident from summoning help, timely showering and meal transportation, proper wound care, adherence to special diet orders, toileting routines, staff marijuana use, and staff sharing resident photos; findings showed some issues with call light functionality but generally no evidence of widespread neglect or misconduct.
    • § 87303(a)
    11 Oct 2023
    Investigated; identified the allegation that the resident's room was not kept in good repair and was uncomfortably warm due to non-working outlets preventing use of a portable AC was not supported by the evidence.
    11 Oct 2023
    Determined that claimed issues with room temperature and electrical outlets in Resident 1's room were addressed, with repairs completed and measures taken to ensure proper cooling, and concluded that the allegation did not meet the criteria for substantiation.
    01 Aug 2023
    Found that staff failed to notify the resident's authorized representative about a change in health condition. Other allegations that staff neglected the resident and that staff failed to meet the resident's needs lacked sufficient evidence.
    01 Aug 2023
    Investigated failed to show that staff notified the authorized representative of the resident’s weight loss, despite the resident losing 24 pounds over four months, and found no evidence that staff neglected or mishandled resident care during mealtimes.
    • § 87468.1(8)
    01 Jun 2023
    Identified the specific allegation that a resident was found with a cup of laundry detergent and detergent around the mouth during rounds. No witnesses and an auto-locking laundry room door left access unclear, and the resident was transported to the hospital and later returned doing well.
    01 Jun 2023
    Found that a resident accessed laundry detergent despite secure doors, resulting in hospitalization, and the incident was deemed substantiated after investigation.
    • § 87705(f)(2)
    30 May 2023
    Found no preponderance of evidence to prove the allegations that two residents did not receive adequate feeding and bathing, that call bells were not answered promptly, and that supervision was insufficient.
    30 May 2023
    Investigated concerns that staff did not take residents to medical appointments, provided inadequate meals, and failed to address a resident's infected feet. Found that some allegations were supported by evidence, while others were not.
    • § 87464(d)
    • § 87631(a)(1)
    30 May 2023
    Identified a persistent insect and mice infestation in the facility and ineffective pest-control efforts. Identified care concerns such as pressure injuries, feeding assistance, toileting care, repositioning, staff communication, and leaving a wheelchair-bound resident in bed for long periods; some allegations had evidence, while others did not have enough evidence.
    30 May 2023
    Reviewed multiple allegations, including an insect infestation, pressure injuries, and resident care concerns; found issues related to pest control but did not verify violations regarding pressure injuries, feeding assistance, toileting, repositioning, staff interaction, or leaving residents unattended.
    • § 87303(a)
    09 May 2023
    Identified that the fire alarm system was in disrepair and three exit lights did not function during a visit on 07/15/22, with the system described as antiquated.
    09 May 2023
    Found that the fire alarm system was in disrepair and had not been replaced despite recommendations, with three egress lights also not functioning during an inspection.
    • § 87203
    11 Apr 2023
    Found that the licensee lacked an adequate financial plan to ensure ongoing resident care and supervision, with inadequate liability insurance and governance accountability issues due to late utility payments and insufficient funds. Found the licensee not in good financial standing, showing negative income and negative equity, and that financial monitoring was required for two quarters.
    11 Apr 2023
    Reviewed financial issues and inadequate liability insurance at a licensed care facility, revealing insufficient financial planning, late utility payments, negative income, and failure to maintain appropriate insurance coverage.
    • § 1569.605
    • § 87205(a)(b)
    • § 87213
    05 Aug 2021
    Determined that lack of supervision during smoking caused a resident to ignite clothing and sustain serious burns, resulting in hospitalization and surgery. A civil penalty of $10,000 was assessed against the licensee for the serious bodily injury.
    23 Mar 2023
    Found the claim that medications were left accessible unfounded. Could not determine whether medications were dispensed per physician orders or whether the resident's fall was attended to promptly.
    23 Mar 2023
    Found the pest control allegation unfounded.
    23 Mar 2023
    Investigated the allegations that the facility left medication accessible and that a resident was left on the floor for hours; found insufficient evidence to support either claim.
    07 Mar 2023
    Identified an insufficient supply of incontinence products to meet 32 residents' needs, with inventory largely limited to medium-sized, tabbed diapers that did not match all residents' requirements.
    07 Mar 2023
    Found that the facility did not have an adequate supply of appropriately sized incontinence products for all 32 residents, leading to a citation.
    • § 87625(a)(1)
    06 Mar 2023
    Investigated allegation that residents paid for services they did not receive, specifically showers not provided because the water was too hot and cable/internet services were unavailable. Interviews with the administrator and staff indicated plumbing problems caused hot water, showers were conducted in unused rooms, and there was not enough evidence to prove the allegation.
    06 Mar 2023
    Identified an allegation that two Sharps Containers were in a resident's room—one in use and another on a shelf—full of syringes and needles. Documented by photographs, the administrator was unaware of the second container.
    06 Mar 2023
    Found that a resident had two full sharps containers in his room, one of which was being used by him and the other stored on a shelf, leading to concerns about proper disposal, which was addressed by the administrator.
    • § 87303(a)
    16 Feb 2023
    Found no health, safety, or personal rights violations and the infection control domain was in substantial compliance.
    16 Feb 2023
    Confirmed that the facility was in substantial compliance with infection control protocols, with no violations observed during the inspection.
    10 Jan 2023
    Investigated two specific allegations—unclean hallway floors and dehydration leading to hospitalization—and found that the evidence did not prove them.
    • § 87303(a)
    10 Jan 2023
    Identified that a resident’s hygiene needs were not consistently met and that indoor temperatures in several areas were uncomfortably high during a hot day.
    10 Jan 2023
    Identified that residents' hygiene needs, specifically showering schedules, were generally met with resident consent, but found that indoor temperatures were uncomfortably hot, exceeding 88 degrees Fahrenheit during a heatwave.
    28 Dec 2022
    Found that staff wore masks during an unannounced visit, and no deficiencies were cited.
    28 Dec 2022
    Confirmed compliance with regulations after addressing findings related to medical and basic services requirements.
    08 Dec 2022
    Found that the resident was given the wrong medication and sent to the hospital as a precaution, later diagnosed with a urinary tract infection and dehydration that staff did not observe. Found that the two communication-related allegations—documentation to the power of attorney within two business days and contacting the doctor or palliative care—could not be proven or disproven because the start date for the two-business-day period was not documented, though a doctor was notified within seven days.
    • § 1569.312(e)
    • § 87465(a)(4)
    08 Dec 2022
    Found insufficient evidence to prove or disprove the call light system malfunctioning allegation. Masks were worn by all staff during the visit, and interviews yielded mixed responses: some said the system worked, while others said the switch was backwards or that any issue was brief and not ongoing.
    08 Dec 2022
    Found laundry equipment in disrepair, laundry services not provided for about a week, and window screens removed for repair. Did not prove or disprove that staff spoke inappropriately to residents or that hallways were not properly lit; found no trip hazard in flooring and PPE was available for staff during an outbreak.
    08 Dec 2022
    Investigated complaints about laundry equipment and window screens; found laundry was delayed due to equipment repairs and some screens were removed for repairs. Also examined concerns about staff speech and hallway lighting, but could not prove or disprove them. Additionally, confirmed flooring was not a trip hazard and staff had adequate PPE during outbreaks.
    • § 87303(a)
    12 Oct 2022
    Identified an incident where a resident eloped from the building through a cafe window into the fenced yard after a perimeter gate was left open, and was away about 45 minutes before being brought back. Noted additional safety and care concerns, including several residents on hospice, possible misassignment of diagnoses, high resident acuity, and sanitation issues such as mold and water leaks observed in multiple areas.
    12 Oct 2022
    Found that an resident with dementia eloped through a gate after staff left it open, and observed high resident acuity amid staffing concerns; additionally, identified safety issues including mold, water damage, and unverified resident diagnoses.
    • § 87555
    • § 87705(c)(4)
    07 Sept 2022
    Identified issues included a malfunctioning fire alarm and inoperable air conditioning; discussed staffing levels, resident census, operations, and Covid-19 infection-control and visitation guidance.
    07 Sept 2022
    Reviewed communication and operational updates from a meeting regarding facility conditions, staffing, infection control, and safety issues such as malfunctioning alarm and air conditioning systems.
    09 Aug 2022
    Investigated a resident's death after staff did not follow medical orders and did not seek timely medical care. Also identified an inaccurate medication dosage and related record-keeping errors, with civil penalties assessed for serious bodily injury.
    • § 87466
    • § 87465(a)(5)
    • § 87465(g)
    09 Aug 2022
    Identified that a resident sustained multiple falls and required supervision and assistance with mobility. Identified that staff did not seek medical attention promptly after the falls, and the resident's belongings were misplaced.
    • § 87217(b)
    • § 87464(f)(1)
    • § 87465(a)(1)
    09 Aug 2022
    Investigated three resident-related concerns: an alleged attack between residents, concerns about residents being left in incontinence products, and a resident entering another resident’s room undressed. Found no preponderance of evidence to prove the alleged incidents occurred.
    09 Aug 2022
    Investigated two allegations: staff discouraged a medical professional from seeing a resident and a questionable death; both were deemed unsubstantiated.
    09 Aug 2022
    Investigated whether staff discouraged a medical professional from seeing a resident and whether a resident’s death was questionable; both allegations were found to lack sufficient evidence to confirm violations.
    22 Jul 2022
    Identified safety and maintenance issues at one site, including a malfunctioning fire alarm, inoperable air conditioning, water heater, and call system, and discussed staffing needs, administrator vacancies, and overall operations across three sites.
    22 Jul 2022
    Identified issues with fire alarms, air conditioning, water heating, and call systems, alongside staffing concerns and vacancies, following citations and facility evaluations discussed during the meeting.
    18 Jul 2022
    Found cooling challenges at the site with portable air conditioners while an aging system is being addressed, and that the fire alarm is antiquated and recommended for replacement. Identified a water heater issue causing lack of cold water output, discussed administrator qualifications and the documents needed to change the administrator, and noted discussions about increasing night-shift staffing.
    18 Jul 2022
    Found that the facility was addressing issues with an outdated fire alarm system, water heater, and cooling, while staffing levels for overnight shifts were being increased; no citations were issued.
    15 Jul 2022
    Identified that a resident eloped from the premises due to a gate mechanism in disrepair, with the gate secured afterward by a cable and lock. Identified that the air conditioning was in disrepair for about a month, the water heater valve needed replacement affecting showers, the fire alarm system was not replaced as recommended, and three egress lights did not function during the assessment.
    15 Jul 2022
    Identified that visitors were barred since 6/24/2022, with visits allowed only through windows and doors locked, and med deliveries left outside until staff retrieved them. Noted indoor temperatures in several rooms (88–94°F) during 100°F outside conditions, with residents reporting heat discomfort; these conditions substantiate the allegations.
    • § 87468.1(a)(11)
    • § 87303(b)(2)
    15 Jul 2022
    Identified lapses in COVID-19 safety, including not screening at the front door and staff not consistently wearing masks, with daily reminders needed. Identified unsafe water conditions due to a faulty water heater valve that prevents temperature control, leading to showers being conducted elsewhere and some residents refusing showers, with water measured at 125 degrees Fahrenheit.
    • § 87464(f)(2)
    15 Jul 2022
    Investigated multiple issues including a resident elopement due to a broken gate, and unaddressed disrepair of the A/C, water system, fire alarm, and gate mechanism; these conditions posed safety concerns and violated regulations.
    • § 87303(a)
    • § 87705(c)(4)
    08 Jun 2022
    Identified that the informal conference addressed licensee/administrator accountability, the transition of management as Peer Services separates, and ensuring all staff are fingerprint cleared and associated. Noted were the submission deadlines for several required forms.
    08 Jun 2022
    Reviewed conversations confirming discussions about licensee responsibilities, facility transitions, staff onboarding procedures, and upcoming documentation deadlines related to licensing compliance.
    20 May 2022
    Investigated an incident on 05/09/2022 where a resident with dementia was pushed by another resident with cognitive decline during a dispute over piano playing, resulting in a right forearm laceration that required stitches; the second resident apologized.
    20 May 2022
    Investigated a resident injury caused by a conflict between residents with cognitive impairments after a resident was pushed during a disagreement over piano playing, resulting in a laceration that required stitches; the facility addressed the incident through a care conference and staff intervention.
    07 Mar 2022
    Found no health, safety, or personal rights issues after a walkthrough and infection-control review, with substantial compliance observed.
    07 Mar 2022
    Found unfounded the allegation that residents' rooms lacked access to phones or televisions, with evidence showing phones and televisions were available in common areas and residents used personal devices.
    07 Mar 2022
    Identified that staff did not wear masks properly at the site, with masks worn under the nose or chin. Found that the allegation of improper masking by staff was supported.
    • § 87470(c)(1)
    07 Mar 2022
    Reviewed evidence and interviews concluded that residents had access to phones and TVs in common areas and personal devices, disproving the allegation that the facility did not provide phones or TVs for residents.
    16 Feb 2022
    Identified two immediate exclusion orders issued to a staff member and to the licensee, restricting access to the site. Implemented COVID-19 safety measures, including testing, daily symptom screening, hand sanitizing, and wearing an N-95, with entry screening by staff.
    16 Feb 2022
    Confirmed the issuance of an immediate exclusion order for a staff member, who was not allowed on the premises, following a formal directive from licensing authorities.
    05 Aug 2021
    Investigated a serious incident where a resident sustained burns after being unsupervised while smoking, leading to hospitalization and surgery, due to inadequate supervision that allowed the resident to exit the facility and ignite their clothing. Determined that a civil penalty was warranted for the injury incurred.
    04 Aug 2021
    Identified a Covid-19 outbreak with multiple residents testing positive and several hospitalizations, and observed two staff not wearing N95 masks. Noted ongoing testing for residents and staff and discussions about PPE and infection control practices.
    04 Aug 2021
    Reviewed infection control measures and COVID-19 protocols during a health and safety check, noting issues with staff mask compliance and emphasizing enhanced signage, staff training, resident safety strategies, and infection prevention practices amid ongoing COVID-19 cases.
    01 Aug 2021
    Found six residents were Covid-positive (four hospitalized, two being evaluated and confirmed positive today), with 22 residents on site and the remainder in hospital or rehab; care needs were being met and no safety concerns were observed. On-duty staffing included one med tech and one caregiver.
    01 Aug 2021
    Reviewed a health and safety check-up noting that the majority of residents' needs were being met, with a COVID-19 outbreak affecting six residents and staffing adjustments in progress, without identifying any safety concerns.
    31 Jul 2021
    Identified that COVID-19 safety protocols were in place on the premises, with staff wearing masks, symptom screenings conducted, and hand hygiene supplies available; no deficiencies were identified.
    31 Jul 2021
    Verified that COVID-19 safety protocols were observed, staff and residents followed proper procedures, and no deficiencies were identified during the visit.
    23 Jul 2021
    Identified that lack of supervision allowed a resident to go outside to smoke, light clothing, and sustain serious burns requiring hospitalization and rehabilitation. A civil penalty of $10,000 was issued for the resulting serious bodily injury.
    23 Jul 2021
    Identified that inadequate supervision on a smoking patio led to a resident igniting clothing and suffering severe burns, resulting in hospitalization and repair, with a civil penalty imposed for the serious injury.
    23 Apr 2021
    Investigated a neglect claim about supervision in a care setting after a resident fell multiple times and found insufficient evidence to prove this claim. Found sufficient evidence to support neglect of personal rights due to staff forgetting to change a resident's soiled diaper for at least two days.
    23 Apr 2021
    Identified neglect related to failing to change a resident’s soiled diaper for over two days, while neglect and lack of supervision were unsubstantiated as no sufficient evidence supported those claims.
    • § 87468.1(a)(2)
    • § 87625(b)(2)
    28 Jan 2021
    Identified safety and storage concerns at the site during a tele-visit pre-licensing review, including a locked closet with resident clothes, a cabinet left unlocked with personal hygiene items, missing mattress pads in rooms, and hot water temperatures outside the required range (101 degrees in one area and 121 degrees in Cottage). Pre-licensing remained incomplete with a completion target of February 8, 2021.
    28 Jan 2021
    Reviewed safety and cleanliness standards, noting issues with locked closets containing personal hygiene items and the absence of mattress pads in some resident rooms; also identified water temperature inconsistencies, with no other deficiencies found.
    12 Oct 2020
    Found the allegation that staff failed to notify the resident's authorized representative in a timely manner and provided inaccurate information to the authorized representative to be unsubstantiated.
    09 Oct 2020
    Found lack of supervision that led to a resident sustaining serious burns on the left leg during smoking after a staff member gave him a cigarette and lighter and did not accompany him as required by the care plan.
    12 Oct 2020
    Investigated the allegation that staff failed to notify the authorized representative of a resident’s burn injury in a timely manner and provided inaccurate information, but there was not enough evidence to confirm these violations.
    09 Oct 2020
    Determined that inadequate supervision led to a resident sustaining serious burns while smoking, and the facility failed to follow the resident’s care plan by providing proper supervision during cigarette use.
    • § 87464(f)(1)
    04 Feb 2020
    Found that staff did not have the resident's DNR paperwork readily available during a 911 call, resulting in CPR being performed before the paramedics accessed the DNR, confirming the allegation regarding the unavailability of the DNR document.
    • § 87469(c)(1)
    23 Jan 2020
    Reviewed an incident involving a resident from January 8th, with discussions and paperwork related to aftercare completed, and no deficiencies cited.
    • § 87464(f)(1)
    03 Jan 2020
    Investigated an incident where an employee posted a photo on social media of a deceased resident in a body bag, leading to counseling and suspension for poor judgment regarding resident privacy.
    • § 87625(b)(2)
    • § 87468.1(a)(2)
    14 Nov 2019
    Reviewed a fall involving a resident who slipped and hit his head in the bathroom, prompting emergency response and hospital evaluation; no hazards were found in the bathroom during inspection.
    03 Oct 2019
    Determined that a resident with mobility issues experienced an unwitnessed fall around lunchtime, was promptly assessed, and received medical attention, with the staff responding appropriately throughout the incident.

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      Truewood by Merrill, Roseville

      1275 Pleasant Grove Boulevard, Roseville, CA, 95747
    • Exterior view of Ivy Park at Roseville, a multi-story senior living facility with beige and brown stucco walls and red tile roofing. The entrance features a covered drop-off area with benches and potted plants. There is a landscaped roundabout with flowers and shrubs, and an American flag flying on a flagpole. The sky is clear and blue.
      $3,000 – $3,900+4.2 (62)
      Semi-private • 1 Bedroom • Studio
      independent living, assisted living, board and care

      Ivy Park at Roseville

      5161 Foothills Blvd, Roseville, CA, 95747
    • Exterior view of a senior living facility named Oakmont of Carmichael with a beige stucco building, tiled roof, landscaped garden with colorful flowers, trees, and a curved walkway. Two people are walking on the path near the entrance.
      $3,795 – $5,495+4.6 (121)
      Studio • Semi-private
      independent, assisted living, memory care

      Oakmont of Carmichael

      4717 Engle Rd, Carmichael, CA, 95608
    • Photo of Oakmont of Fair Oaks
      $3,995 – $6,595+4.4 (87)
      Studio • 1 Bedroom • Semi-private
      assisted living, memory care

      Oakmont of Fair Oaks

      8484 Madison Ave, Fair Oaks, CA, 95628
    • Front exterior view of a senior living facility named 'the Chateau' with a covered entrance, surrounded by lush green trees and landscaped flower beds. There are chairs and an American flag near the entrance.
      $4,400 – $9,155+4.2 (90)
      Studio • 1 Bedroom • 2 Bedroom
      independent, assisted living, memory care

      River's Edge

      601 Feature Dr, Sacramento, CA, 95825

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    Senior living guides

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