Tedenek Elder Home 2

Type of visit: Required - 1 Year

On February 23, 2026 Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Shemeles Kabteneh. Facility is licensed for 6 residents and has a current census of 5. There are 2 residents on hospice, and care plans are current. R1 and R2 are on hospice with doctor orders for full bed rails. Water temperature was checked in the kitchen which read at 118 degrees Fahrenheit. Fire Extinguisher was serviced 03/21/2025 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested and in working order. Shemeles Kabteneh Administrator's Certification expired 12/7/2025, and is pending renewal. Staff files were reviewed, LPA observed training to not be current. Resident files were reviewed. Facility was able to provide a log for disaster drills that are conducted quarterly. First aid kit on site and complete. LPA observed toxins and cleaning supplies accessible in the garage. LPA observed cleaning supplies and rubbing alcohol accessible in R1's bathroom. There is a locked storage for medications. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. The garage of the facility is listed as an emergency exit, LPA observed a car and furniture partially blocking a path to exit the garage door. Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights to Shemeles Kabteneh.the state’s words, verbatim · CDSS document, Feb 23, 2026

Type of visit: Required - 1 Year

On 1/31/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced himself, stated the purpose of the visit, and was greet by Staff (S1) Yuliana Yap, LPA was granted entry. 4 residents were present during inspection. Licensee (A1) Shemeles Kabteneh arrived shortly after LPA’s arrival. LPA toured facility with L1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. A sample of resident’s medications were checked and observed kept locked in medication cabinet. Clients’ MARS was reviewed. Morphine Sulfate 20 MG/1ML SOL .25 ML (5MG) by mouth or under the tongue every 1 hour as needed for pain or shortness of breath was observed in the refrigerator unlocked and accessible. Fire extinguisher reviewed with a service date of: 3/1/24. Fire drill not completed and no record observed in facility. Cleaning chemicals was observed stored and locked in facility cabinet. Residents bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 113.9 to 116.7 degrees in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. No thermometers observed in freezer or refrigerator, therefore no temperature was recorded during visit. Carbon monoxide were tested and observed to be operational. All clients’ files reviewed. 2 out of 4 residents is missing Consent for Medical treatment form. 3 out of 4 residents are missing the Appraisal Needs and Services form. 3 out of 4 residents are missing the Safeguard for Property Values form. All staff files were reviewed. Licensee is missing LIC-501 or Employee/License application, Medication Completion Certificate and a written copy of completed education. The following deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 2/14/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance-RCFE, Emergency and Disaster Plan (LIC 610E -RCFE), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A- RCFE) A copy of this report and appeal rights was provided to L1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Required - 1 Year

On 03/18/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Shemeles Kabteneh, via telephone. Administrator arrived a short time later. LPA conducted a tour inside and outside of facility. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measured at 117.1 degrees F. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching. Fire extinguisher serviced on 04/03/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. The date of the last fire drill was not documented. All cleaning supplies are locked and inaccessible. LPA reviewed staff and client records. Upon review of records, LPA found that 3 out of 3 residents did not have a complete resident file. 2 out of 2 residents receiving hospice services did not have a hospice care plan on file. Staff records were observed to be complete with 1st Aid/CPR and health screen. Medications reviewed and observed to have original labels and be administered as prescribed. First Aid Kit contained the required supplies. Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. LPA is requesting the following documents be submitted to the Fresno CCL office by 04/01/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond. Exit interview conducted and plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Shemeles Kabteneh, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Mar 18, 2024

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Post Licensing

On 01/24/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Shemeles Kabteneh via telephone. Administrator is unable to attend this inspection. LPA received verbal permission to meet with Facility Staff, Azeb Biratu. LPA conducted a tour inside and outside the facility, and reviewed facility records. LPA observed the following: Facility currently has 2 residents. Facility observed to be clean, odor free, and at a comfortable temperature. The dining room and living room were furnished well with adequate seating and lighting. Resident rooms appeared clean and had all required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars and non-skid mats. Hot water measured at 115.6 degrees F. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Knives/Sharps observed to be locked in a kitchen drawer. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching. Fire extinguisher serviced on 04/03/23. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. All chemicals observed to be locked and secure in a cabinet in the laundry room. Medications observed to be inaccessible to persons in care and administered as prescribed. No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Facility Staff, Azeb Biratu, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jan 24, 2024

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.