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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002441
Report Date: 09/16/2026
Date Signed: 09/16/2026 03:24:02 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
07/06/2026 and conducted by Evaluator Kayla Adkison
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260706142739
FACILITY NAME:AMBER GROVE PLACEFACILITY NUMBER:
045002441
ADMINISTRATOR:BAXTER, STACYFACILITY TYPE:
740
ADDRESS:3049 ESPLANADETELEPHONE:
(530) 826-3226
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:70CENSUS: 50DATE:
09/16/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Stacey Baxter, AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility raised level of care rates without clear explanation
INVESTIGATION FINDINGS:
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On XXX, 2026, Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility unannounced for the purpose of delivering complaint findings. LPA was greeted by Administrator Stacy Baxter and explained the purpose of the visit. During the visit, there were 50 residents in the community and 10 care staff.

During the course of the investigation, interviews were conducted, observations were made, and pertinent records were reviewed.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026
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-20260706142739
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: AMBER GROVE PLACE
FACILITY NUMBER: 045002441
VISIT DATE: 09/16/2026
NARRATIVE
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Allegation: Facility raised level of care rates without clear explanation

It was alleged that facility representatives raised the monthly rates of Resident 1’s (R1) care without providing a clear written explanation for the change to R1’s responsible party (RP).

On June 16, 2026, a care conference was held with facility staff and R1’s RP to discuss R1’s care needs and concerns. During this meeting, RP was initially provided a “Level 2” care plan describing the services and interventions that were to be provided to R1 as part of R1’s daily routine. During the meeting, a present staff member verbally changed the care plan to a “Level 3” citing the fact that R1 is now needing stand-by assistance with showering for their safety and to ensure cleanliness. R1’s RP requested a copy of a level 3 care plan which was unavailable for their review.

LPA interviewed facility managerial staff who provided LPA with a Care Services and Fees document indicating the services provided for each level of care. At the bottom of this document, there was an asterisked statement claiming, “Level of care pricing subjected to change without notice.” LPA interviewed care staff at the facility who stated R1 was still primarily independent with the majority of their Activities of Daily Living (ADLs), but they had noticed a gradual decline in R1’s ability to cleanse themselves properly to ensure R1’s own health and hygienic safety. Additionally, staff reported R1 had begun to exhibit more confused behaviors and needed more reminders and stand-by assistance throughout the day, specifically with toileting and showering.

However, LPA reviewed R1’s Admission Agreement and noted that on page 16 under the heading “Change of Level of Care, “the document states “if we (facility) determine that you need a level of care that is different from your current level, we will provide you and your RP with written notice of that change.” LPA reviewed an email dated July 8, 2026, to R1’s RP from facility administrator, Stacey Baxter, containing the level three (3) care plan that RP had requested over three (3) weeks prior. This was the first time the RP had been provided a level three (3) care plan for the resident when RP had already been directed to pay for level three (3) care for half of June 2026 and all of July 2026.

Based on interviews conducted, observations, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260706142739
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: AMBER GROVE PLACE
FACILITY NUMBER: 045002441
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2026
Section Cited
CCR
87507(f)
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87507 Admission Agreements
(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments The requirement is not met as evidenced by:
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Administrator shall submit a statement of understanding of the allegation to LPA by end of business on September 25, 2026.
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Based on interviews conducted, observations, and records reviewed, it was determined that staff did not adhere to the admission agreement provided to the resident in that the staff did not provide a written copy of the residents updated care plan indicating a change in the level of care for over three (3) weeks. This poses a potential health, safety, and/or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3