Gelila Residential Care Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct the annual inspection. LPA met with Desta Gebemeskel, Administrator, and she was explained the purpose of the visit . The facility is licensed to serve (6) non- ambulatory residents aged 60 and over. Non-Ambulatory residents are approved for rooms # 2, 3 and 4 and the facility has an approved hospice waiver for (6) residents. There are three (3) residents that have dementia at time of visit. There are no residents receiving home health or hospice care. This home is a single-story home consisting of: (4) four resident bedrooms, (2) Full bathroom, living room/ office, kitchen with dining area/den and an outdoor shaded patio area. At 12:45 PM, LPA reviewed four (4) residents files for admission agreements, updated physician reports, and needs and services plan which appeared to be up to date. LPA also conducted an audit of three(3) residents’ medications, and it appears that residents are given their medications as prescribed by their physicians. At 1:35 PM, LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings which were all current. LPA inspected a total of four (4) bedrooms, the beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The two (2) bathrooms appeared to be in good condition with handrails and operational. The water temperature ranged from 105°F to 120. °F. LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was a 5-day supply of perishable and a 7day supply of non-perishable food items which was adequately maintained/stored. The fire extinguishers, carbon monoxide detectors and smoke detectors were fully charged and operable. The last Fire/Disaster drills were conducted on 3/1/2026. During the inspection LPA Allen did not observe deficiencies therefore no citations were issued. An exit interview was conducted, where this report was discussed and provided to Desta Gebemeskel, Administrator, at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 22, 2026

Allegation investigated: Staff do not ensure that resident's dietary needs are met. Staff do not provide resident with privacy during phone calls.

**This report does not supersede the complaint investigation conducted on 03/19/2026 but is used to clarify findings. ** On 07/17/2026 LPA Watson conducted a complaint visit to the facility listed above. LPA Watson met with the licensee, Aderra Yohannes, and explained the purpose of the visit. LPA Watson was granted entry into the facility. The investigation consisted of the following:On 03/19/2026 LPA Watson requested and obtained copies of the following documents: Staff Roster, Personnel Report, Appraisal/Needs and Services Plan dated 07/13/2025 for R1, Telecommunications Device Notification, Physician’s Report dated 07/13/2025, Personal Rights dated 10/03/2024, Gelila’s Daily Activities for R1 dated 01/05/2026 to 03/02/2026, and Gelila Residential Care Suggested Menu for R1. CONTINUED ON LIC9099-C Unsubstantiated On 03/17/2026, The department conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4 #5 (R1–R5) including the conservator for R2 Witness#1 (W1) was also interviewed. Allegation: Staff do not ensure that residents’ dietary needs are met It is alleged that staff do not ensure that R1’s dietary needs are met, including concerns about inadequate meal variety, hydration, and lack of fruits and vegetables. On 03/19/2026 between 08:16 AM and 04:50 PM, LPA Watson conducted an interview with the licensee (S1). During the interview, LPA Watson asked S1 if staff ensured that R1’s dietary needs were met. S1 stated that the facility provides residents with three daily meals and snacks, offering a variety of foods such as chicken, beef, eggs, salads, steamed vegetables, rice, beans, fruit cups, apples, oranges, and yogurt. S1 stated that residents are given choices according to their preferences and that meals are adjusted when residents request alternatives. S1 stated that staff do not serve cereal or oatmeal for dinner unless a resident specifically requests it. S1 confirmed that no residents have special diets prescribed by a physician, except that R1 must avoid grapefruit due to a medication interaction. S1 stated that facility staff makes efforts to accommodate R1’s food preferences because he is a selective eater. On 03/17/2026, The department conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4 #5 (R1–R5). Out of those interviewed 3 out of 3 staff, 4 out of 4 residents and the conservator for R2 Witness#1 (W1) also denied the above allegation. On 03/19/2026, the department obtained and reviewed the Suggested Menu Items for R1. The review showed that the facility provides breakfast items such as eggs, toast, fruit, and oatmeal; lunch items such as sandwiches, salads, rice, and vegetables; and dinner items such as baked chicken, pasta, mixed vegetables, rice, and beans. The department reviewed Daily activity records which also showed R1 consistently received snacks including fruit cups, yogurt, crackers, and juice upon request. The department reviewed California Code of Regulations, Title 22, Division 6 Chapter 8 Article 10 Food services 87555 General Food Service Requirements, which requires facilities to provide well balanced meals, including fruits, vegetables, protein, whole grains, and adequate fluid intake. Based on interviews, record reviews, and observations, R1's meals and hydration opportunities were found to be consistent with Title 22 requirements. CONTINUED ON LIC9099-C The department obtained and reviewed a copy of the facility menu and it showed a monthly/weekly listing of breakfast, lunch and dinner for R1 and it is was found to be consistent with Title 22 87555 General Food Service requirements. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that “Staff do not ensure that residents’ dietary needs are met.” Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated. Allegation: Staff do not provide residents with privacy during phone calls It is alleged that staff do not provide R1 with privacy during phone calls, because staff reportedly place his cell phone on speaker mode when R1 answers his phone calls. On 03/19/2026 between 08:16 AM and 04:50 PM, LPA Watson conducted interviews with the licensee (S1). During the interview, the department asked S1 if staff provided R1 with privacy during phone calls and S1 stated staff reported that residents are allowed to use either the house phone or their personal phones in private. Staff stated that R1 is permitted to make and receive calls privately and that assistance is provided only when R1 is unable to operate his personal phone or when his conservator contacts the facility directly. Staff stated that when assisting R1, calls are placed on speaker solely to allow him to hear the caller due to his hearing needs, after which R1 is given privacy by speaking in another room or by staff leaving the area. On 03/17/2026, The department conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4 #5 (R1,R3,R4, R5). Out of those interviewed 3 out of 3 staff, and 4 out of 4 residents including the conservator for R2 Witness#1 (W1) denied the above allegation. On 03/19/2026, the department obtained and reviewed the Telecommunications Device Notification for R1. This document stated that any deaf, hearing impaired, or otherwise impaired resident of any community care facility is entitled to equipment and service, pursuant to Section 2881 of the California Public Utilities Code, to improve the quality of their telecommunications. Out of those interviewed, staff and residents stated there are no phone restrictions enforced by the facility, and residents confirmed they can make private phone calls. CONTINUED ON LIC9099-C Based on interviews, records, and observations, R1 is permitted to make and receive private calls, and assistance is provided only when needed for hearing or technical reasons. There is insufficient evidence to support the allegation that “Staff do not provide residents with privacy phone calls.” Therefore, the allegation is deemed Unsubstantiated. An exit interview was conducted with the Licensee Aderra Yohannes and a copy of this report was providedthe state’s words, verbatim · CDSS document, Jul 17, 2026 · control 11-AS-20260311094348

Allegation investigated: Facility staff is financially abusing resident. Facility staff are not treating residents with dignity and respect. Facility staff did not ensure resident was using medical device as prescribed. Staff do not schedule structured activities for residents.

**This report does not supersede the complaint investigation conducted on 03/17/2026 but is used to clarify findings**. On 07/17/2026 at approximately 8:38 AM, Licensing Program Analyst (LPA) Troy Watson conducted a subsequent complaint visit. The department met with the Licensee, Ada Yohannes, and explained the purpose of the visit. The department was granted entry into the facility. The investigation consisted of the following: On 03/17/2026, the department requested, obtained, and reviewed copies of the following documents: Personnel Report dated 06/10/25, Resident Roster 2026, House Rules for R1, R4, and R5, Admission Agreements dated 03/29/25, 08/15/24, and 10/03/24, Personal Rights for R1, R4, and R5, CONTINUED ON LIC9099-C Unsubstantiated Unusual Incident Reports for R1, R4, and R5, Telecommunication Device Notifications for R1, R4, and R5, Continued Monthly Resident Report for R3 dated 01/31/26, Care Facility LLC Invoices for R1, R4, and R5, Residential Care Facility Agreement (CA Provider Contract), Gmail correspondence regarding payment decrease dated 02/16/2026, Gmail correspondence requesting invoices dated 03/13/2026, InnovAge/PACE Supportive Housing Authorization and Client Payment dated 02/13/2026, and the facility Activity Schedule. The department also conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4, #5 (R1–R5). An attempt to interview Resident #2 (R2) was made; however, R2 was unable to respond to the interview questions at the time of the visit. A separate interview with the spouse of R2 was documented as Witness #1 (W1). On 07/16/2026 at approximately 02:30 PM, the department conducted additional interviews with Staff #1–#2 (S1–S2), Resident #2 (R2), and the power of attorney for Resident #3 (R3), documented as Witness #2 (W2). An attempt to interview Resident #1 was made; however, R1 was no longer at the facility at the time of visit. Investigation revealed the following: Allegation: Facility staff are financially abusing a resident It is alleged that facility staff are financially abusing R1 by withholding or misrepresenting the receipt of their monthly rent grant funds. On 03/17/2026 between 8:45 AM and 4:00 PM, the department interviewed the Administrator (A1). When asked about R1’s rental payments or rent related funds, A1 stated that no such incidents have occurred. A1 explained that the facility does not handle R1’s money or collect resident funds onsite, as rent payments are made directly by outside payors. A1 stated that a percentage of R1’s rental payments is paid by R1’s conservator and the balance of R1’s rental payments, as stated in contractual agreements, is paid by InnovAge/PACE via check, and R1’s conservator submits electronic payments directly to the Licensee via Zelle. CONTINUED ON LIC9099-C A1 was also asked directly to describe any situations where staff may have accessed, handled, or used R1’s money or personal belongings without permission. A1 responded no, stating that residents’ families pay their rent by either personal checks or by sending rent payments via Zelle, and that R1’s personal belongings were kept neatly in his private room. On 03/17/2026, the department conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4, #5 (R1–R5). Out of those interviewed, 3 out of 3 staff, 4 out of 4 residents, and the spouse/conservator of R2, Witness #1 (W1), denied the above allegation. On 07/16/2026 at approximately 02:30 PM, the department conducted additional interviews with Staff #1–#2 (S1–S2), Resident #2 (R2), and Witness #2 (W2). Out of those interviewed, 2 out of 2 staff denied the above allegation, and 1 resident and 1 power of attorney also denied the above allegation. An attempt to interview R1 was made, but R1 was no longer at the facility. On 03/17/2026, the department reviewed Gmail correspondence indicating a decreased InnovAge payment dated 02/16/2026, showing a total of $2,234 due for January. A follow up email dated 03/13/2026 showed that InnovAge requested invoices to confirm the outstanding balance and indicated that remaining payments would be issued. The department requested and obtained documentation from the facility showing that the resident’s rental payment balance was paid in full by InnovAge on 04/17/2026 in the amount of $2,968.00. The department also reviewed R1’s Authorization and Client Payment document, which showed R1’s gross income and the total co payment amount paid by InnovAge to the facility dated 02/13/2026. The department concluded that R1 has not been financially abused by the facility and that all monies for R1’s rental payments have been paid in full. The department observed R1’s room neat, clean, and in good repair. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that facility staff are financially abusing a resident. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. CONTINUED ON LIC9099-C Allegation: Facility staff are not treating residents with dignity and respect It is alleged that facility staff are not treating R1 with dignity and respect, including turning off the television, restricting phone use, and refusing to provide the Wi Fi password. On 03/17/2026 between 8:45 AM and 4:00 PM, the department interviewed A1. When asked whether staff ever spoke to or interacted with residents in a disrespectful manner or in a way that violated personal rights, A1 stated no. A1 was asked whether R1 had been disrespected by having his television turned off, having phone use restricted, or being denied the Wi Fi password. A1 stated that community TV is not permitted after 9:00 PM; however, R1 may watch TV in his bedroom at any time. A1 further stated that the Wi Fi password is available to all residents and that R1 has his own cell phone, which he may use freely. On 03/17/2026, interviews were conducted with Staff #1–#3 (S1–S3) and Residents #1, #3, #4, #5 (R1–R5). Out of those interviewed, 3 out of 3 staff, 4 out of 4 residents, and Witness #1 (W1) denied the above allegation. On 07/16/2026 at approximately 02:30 PM, the department conducted additional interviews with Staff #1–#2 (S1–S2), Resident #2, and Witness #2 (W2). Out of those interviewed, 2 out of 2 staff denied the above allegation, and 1 resident and 1 power of attorney also denied the above allegation. An attempt to interview R1 was made, but R1 was no longer at the facility. On 03/17/2026, the department reviewed R1’s Telecommunications Device Notification dated 08/15/2024, which shows on page two, item 14, that R1 is allowed access to telephones to make and receive confidential calls. The department also reviewed the House Rules, which state that community TV use must be respectful, with no violent movies and appropriate volume control. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff are not treating residents with dignity and respect. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. CONTINUED ON LIC9099 - C Allegation: Facility staff did not ensure a resident was using a medical device as prescribed It is alleged that facility staff did not ensure R1 used his prescribed medical devices as required. On 03/17/2026 between 8:45 AM and 4:00 PM, the department interviewed A1. When asked what staff do to ensure residents use prescribed medical devices correctly and consistently as ordered by their physician, A1 stated that all staff are trained and assist R1 nightly by adding distilled water to his CPAP machine and inserting duodenal tubes into his nostrils at bedtime. On 03/17/2026, the department conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4, #5 (R1–R5). Out of those interviewed, 3 out of 3 staff, 4 out of 4 residents, and Witness #1 (W1) denied the above allegation. On 07/16/2026 at approximately 02:30 PM, the department conducted additional interviews with Staff #1–#2 (S1–S2), Resident #2, and Witness #2 (W2). Out of those interviewed, 2 out of 2 staff denied the above allegation, and 1 resident and 1 power of attorney also denied the allegation. An attempt to interview R1 was made, but R1 was no longer at the facility. The department toured the facility with the Licensee and observed R1’s CPAP machine in his bedroom. The machine appeared clean, operational, and in good repair, with a clean bottle of distilled water placed next to it. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff did not ensure R1 used his prescribed medical device as required. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. Allegation: Staff do not schedule structured activities for residents It is alleged that facility staff do not allow residents to venture away from the facility to enjoy outdoor activities or provide scheduled structured activities for residents. The facility provides an activity area with games and a television, outdoor walking areas, a backyard, and community outings for residents, including residents who use wheelchairs. On 03/17/2026, the department conducted interviews with Staff #1–#3 (S1–S3) and Residents #1, #3, #4, #5 (R1–R5). Out of those interviewed, 3 out of 3 staff, 4 out of 4 residents, and Witness #1 (W1) denied the above allegation. CONTINUED ON LIC9099 - C On 07/16/2026 at approximately 02:30 PM, the department conducted additional interviews with Staff #1–#2 (S1–S2), Resident #2, and Witness #2 (W2). Out of those interviewed, 2 out of 2 staff denied the above allegation, and 1 resident and 1 power of attorney also denied the allegation. An attempt to interview R1 was made, but R1 was no longer at the facility. The department interviewed R1 regarding the types of activities the facility offered and what he participated in. R1 stated that they attended InnovAge/PACE Day Care, watched television, and went to restaurants and parks with their daughter. The department reviewed the activity calendar provided by InnovAge/PACE, which showed various activities for the residents such as board games, tennis, painting, field trips, aerobics, basketball, and arts and crafts. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff do not schedule structured activities for residents. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited, and no citation was issued. An exit interview was conducted with the Licensee, Aderra Yohannes, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2026 · control 11-AS-20260309083113

Allegation investigated: Staff do not ensure that resident's dietary needs are met. Staff do not provide resident with privacy during phone calls.

On 03/19/2026 between 08:16 AM and 04:50 PM, LPA Troy Watson conducted an initial complaint visit. LPA Watson met with the Owner Aderra Yohannes and explained the purpose of the visit. LPA Watson was granted entry into the facility. The investigation consisted of the following: On 03/19/2026 LPA Watson requested, and obtained copies of the following documents: Staff Roster, Personnel Report, Appraisal/Needs and Services Plan dated 07/13/2025 for R1, Telecommunications Device Notification, Physicians Report dated 07/13/2025, Personal Rights 10/03/2024, Gelila’s Daily Activities for R1 dated 01/05/2026 to 03/02/2026, and Gelila Residential Care Suggested Menu for R1, CONTINUED ON LIC9099-C Unsubstantiated Allegation: Staff do not ensure that residents’ dietary needs are met It is alleged that staff do not ensure that R1’s dietary needs are met, including concerns about inadequate meal variety, hydration, and lack of fruits and vegetables. On 03/19/2026 between 08:16AM and 04:15 PM LPA Watson conducted interviews with Staff #1 - (S1-S4) and Residents #1- #3 (R1- R3). On 03/19/2026, between 08:16 AM and 04:50 PM, LPA Watson conducted an interview with the Owner (S1). During the interview, LPA Watson asked S1 if staff ensured that R1’s dietary needs were met. S1 stated that the facility provides residents with three daily meals and snacks, offering a variety of foods such as vegetables, rice, beans, salads, fruits, and proteins. S1 also stated that residents are given choices according to their preferences and that meals are adjusted when residents request alternatives. S1 also said that staff do not serve cereal or oatmeal for dinner unless a resident specifically requests it. S1 confirmed that no residents have special diets prescribed by a physician, except that R1 must avoid grapefruit due to a medication interaction. S1 reported that staff make efforts to accommodate R1’s food preferences because he is a selective eater. On 03/19/2026, LPA Watson obtained and reviewed the Suggested Menu Items for R1. The review showed that the facility provides a variety of normal foods for R1 for breakfast, lunch, and dinner. An interview with staff revealed that R1 was consistently given snacks at the facility whenever R1 requests. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff “Staff do not ensure that residents’ dietary needs are met.” Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated. Allegation: Staff do not provide residents with privacy during phone calls It is alleged that staff do not provide R1 with privacy during phone calls, because staff reportedly place his cell phone on speaker mode when R1 answers his phone calls. CONTINUED ON LIC9099-C On 03/19/2026 between 08:16AM and 04:50 PM LPA Watson conducted interviews with the Owner (S1). During the interview LPA Watson asked S1 if staff provided R1 with privacy during phone calls and S1 said Staff reported that residents are allowed to use either the house phone or their personal phones in private. Staff stated that R1 is permitted to make and receive calls privately and that assistance is provided only when R1 is unable to operate his personal phone or when his conservator contacts the facility directly. Staff reported that when assisting R1, calls are placed on speaker, solely to allow him to hear the caller due to his hearing needs, after which R1 is given privacy by speaking in another room or by staff leaving the area. On 03/19/2026 LPA obtained and reviewed the Telecommunications Device Notification for R1, and it stated that any deaf or hearing impaired or otherwise impaired resident of any community care facility is entitled to equipment and service, pursuant to Section 2881 of the California Public Utilities Code, to improve the quality of their telecommunications. Based on interviews with the residents and staff there are no phone restrictions enforced by the facility. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that Staff do not provide residents with privacy during phone calls. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited, and no citation was issued. An exit interview was conducted with the Owner Aderra Yohannes and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 19, 2026 · control 11-AS-20260311094348

Allegation investigated: Facility staff is financially abusing resident. Facility staff are not treating residents with dignity and respect. Facility staff did not ensure resident was using medical device as prescribed. Staff do not schedule structured activities for residents.

On 03/17/2026 at approximately, LPA Troy Watson conducted an initial complaint visit. LPA Watson met with the Owner Ada Yohannes and explained the purpose of the visit. LPA Watson was granted entry. The investigation consisted of the following: On 03/17/2026 LPA Watson requested, obtained and reviewed copies of the following documents: Personnel Report dated 06/10/25 and Resident Roster 2026, House Rules for R1,R4, R5, Admission Agreements dated 03/29/25,08/15/24, 10/03/24, Personal Rights for R1,R4,R5, Unusual Incidents Report for R1,R4 ,R5, Telecommunication Device Notifications for R1,R4,R5, Continued Monthly Resident for R3 dated 01/31/26, Care Facility LLC Invoices for R1, R4,R5 and Residential Care Facility Agreement (CA Provider Contract),Gmail: email correspondence InnoVage decrease in payments email dated 02/16/2026 and Gmail: email correspondence Invoice needed dated 03/13/2026. CONTINUED ON LIC9099-C Unsubstantiated investigation revealed the following: Allegation: Facility staff are financially abusing a resident It is alleged that facility staff are financially abusing R1 by withholding or misrepresenting the receipt of their monthly rent grant funds. On 03/17/2026, between 8:45 AM and 4:00 PM, LPA Watson interviewed the Administrator (A1). A1 was asked whether they were aware of any situations in which staff accessed, handled, or used a resident’s money or personal belongings without permission. A1 stated there have been no such incidents. A1 further explained that the facility does not handle R1’s money or keep any resident funds on site, as payments to the facility are made directly through InnovAge, and family members submit electronic payments via Zelle. On 03/17/2026 LPA Watson conducted interviews with Staff #1-#3 (S1-S3) and Residents #1 - 5 (R1- R5). Out of 3 staff members interviewed, 3 out of 3 staff denied the above allegation. Out of 5 residents interviewed 5 out of 5 residents denied the above allegation. On 03/172026 LPA Watson reviewed Gmail correspondence, including an InnovAge payment decrease email dated 02/16/2026, which showed a total of $2,234 due to Gelila for January. A second email dated 03/13/2026 indicated that InnovAge agreed to pay the remaining balance owed to Gelila Residential and requested invoices to confirm the outstanding amount. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff unlawfully evicted a resident. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. Allegation: Facility staff are not treating residents with dignity and respect It is alleged that facility staff are not treating R1 with dignity and respect, including turning off their television, restricting phone use, and refusing to provide the Wi Fi password. CONTINUED ON LIC9099 -C On 03/17/2026 between 8:45 AM and 4:00 PM, LPA Watson interviewed the Administrator (A1). When asked whether they had ever observed staff speaking to residents or interacting with them in a disrespectful manner or in a way that violated personal rights, A1 stated no. A1 was also asked whether R1 had been disrespected, by having his television turned off, his phone use restricted, or being denied the Wi Fi password. A1 stated that community TV is not permitted after 9:00 PM, however, R1 may watch TV in his bedroom. A1 further stated that the Wi Fi password is available to all residents and that R1 has his own cell phone, which he may use at any time. On 03/17/2026 LPA Watson conducted interviews with Staff #1-#3 (S1-S3) and Residents #1 - 5 (R1- R5). Out of 3 staff members interviewed, 3 out of 3 staff denied the above allegation. Out of 5 residents interviewed 5 out of 5 residents denied the above allegation. LPA Watson reviewed R1’s Telecommunications Device Notification dated 08/15/2024, which shows on page two, item 14, that R1 is allowed access to telephones to make and receive confidential calls. LPA also reviewed the House Rules, which state on line 4 that community TV use must be respectful, with no violent movies and appropriate volume control. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff unlawfully evicted a resident. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. Allegation: Facility staff did not ensure a resident was using a medical device as prescribed It is alleged that facility staff did not ensure R1 used his prescribed medical devices as required. On 03/17/2026 at 8:45 AM and 4:00 PM, LPA Watson interviewed the Administrator (A1). When asked what staff do to ensure residents use their prescribed medical devices correctly and consistently as ordered by their physician, A1 stated that all staff are trained and assist R1 each night by adding distilled water to his CPAP machine and inserting the duodenal tubes into his nostrils at bedtime. On 03/17/2026 LPA Watson conducted interviews with Staff #1-#3 (S1-S3) and Residents #1 - 5 (R1- R5). Out of 3 staff members interviewed, 3 out of 3 staff denied the above allegation. Out of 5 residents interviewed 5 out of 5 residents denied the above allegation. CONTINUED ON LIC9099-C LPA Watson toured the facility with the owner and observed R1’s CPAP machine in his bedroom. The machine appeared clean, operational, and in good repair, with a clean bottle of distilled water placed next to it. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff unlawfully evicted a resident. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. Allegation: Staff do not schedule structured activities for residents It is alleged that facility staff do not provide or schedule structured activities for residents. The facility also provides an activity area with games and a television, outdoor walking areas, a backyard, and community outings for residents, including those who use wheelchairs. On 03/17/2026 LPA Watson conducted interviews with Staff #1-#3 (S1-S3) and Residents #1 - 5 (R1- R5). Out of 3 staff members interviewed, 3 out of 3 staff denied the above allegation. Out of 5 residents interviewed 5 out of 5 residents denied the above allegation. LPA Watson interviewed R1 and asked about the types of activities offered each day and whether there is a structured activity schedule. R1 stated that they go to Day Care, watch TV, and go to restaurants and parks with their daughter. Based on interviews, record reviews, observations, and the information gathered, there is insufficient evidence to support the allegation that staff unlawfully evicted a resident. Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited, and no citation was issued. An exit interview was conducted with the Administrator Aderra Yohannes and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 11-AS-20260309083113

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Desta Gebemeskel, Administrator and the purpose of the visit was discussed. Facility is licensed to serve (6) non- ambulatory residents age 60 and over . The facility has an approved hospice waiver for (6) residents. Non Ambulatory rooms include room # 2, 3 and 4. Three (3) of the residents have dementia at time of visit. None of the residents are receiving home health care. Two (2) residents are receiving hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (4) resident bedrooms, (2) Full bathroom, living room/ office, kitchen with dining area/ den, l washer and dryer located in dining area and an outdoor shaded patio area. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 112.F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. No deficiencies were observed during visit. Exit interview conducted with Desta Gebemeskel, Administrator. A copy of this report was provided at time of visit.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Prelicensing

On 05/24/2024 Licensing Program Analysts (LPA) Troy Watson conducted a pre-licensing evaluation for Gelilal Residential Care Facility. Today’s pre-licensing evaluation was conducted with the Administrator Christian Yohannes. The licensee has applied for a license to serve (6) ambulatory adults and (6) non-ambulatory residents. The fire clearance is approved for (6) ambulatory and (6) non-ambulatory residents. The building is equipped with (7) smoke/carbon monoxide detectors and 2 fully charged fire extinguishers with two exits for the residents. A tour of the Kitchen, (2) Dining Room, (2) Living Rooms, (4) bedrooms, (2) bathrooms, shaded patio area, (1) Office, (1) Shed, (1) Storage area and perimeter of the facility for the clients was inspected by the LPA. Inspection of the inside and outside perimeters were conducted with the Administrator Christian Yohannes. Storage for all PPE are in a supply room which is located outside in the back of the main facility. Food, extra bedding, and linen was inspected and adequately furnished for the residents. A back yard with chairs and a shaded patio area was also observed. The front and back entrance of the facility has Exit signs and wheel chair ramps accessible to residents. SUPPLIES There are clients’ personal hygiene supplies to include soap, toothpaste, toilet paper, and comb. There is a sufficient supply of clean linens to permit weekly changing of clients’ top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. The facility currently has one refrigerator fully stocked with food. Freezer is 0° Fahrenheit. Refrigerator is a maximum of 45° Fahrenheit. A pantry located inside the kitchen has a (7) day supply of non-perishable food present. There are enough tableware, tables, dishes, and utensils. There is enough equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained, kitchen, food storage, and preparation areas are clean. RECORDS There is a confidential storage space designated for client and personnel records at the facility. The following was observed during this visit: MEDICATIONS There is a locked centralized storage area for clients’ medications inside the administrator’s office. PHYSICAL PLANT Facility is clean, sanitary, and in good repair. Protective devices are in place. Indoor and outdoor passageways, stairways, an open porch, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68°F. degrees and 73°F. degrees. Open porches, and areas of potential hazard are well-lit. All (7) Smoke alarms were tested and operate properly. Carbon monoxide detectors operate properly. BEDROOMS All bedrooms have lamps, chairs, and sufficient lighting, mattresses, and pillows. There are 4 bedrooms in the main facility with dresser drawers and adequate closet space. Each room has night stands. And there is sufficient lighting in the hallway. BATHROOMS There are (2) bathrooms with accessible to the residents. There are (2) showers and (1) bathtubs. The hot water temperature in bathrooms and kitchen is between 112° Fahrenheit and 119.5° Fahrenheit. The bathrooms are located next to the bedrooms in the hallway. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. A Licensing Complaint Poster See Something, Say Something is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a table and chairs furnished for outdoor use. There is at least one common room available to clients for visitors. A Component III PowerPoint presentation, and exit interview was conducted with the Administrator Christian Yohannes. A copy of this report was provided.the state’s words, verbatim · CDSS document, May 24, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Christian Yohannes (A), Desta Gebremeskel (C) Interview Method: Telephone interview On April 5, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. General Provisions/Medications/Activities 3. Staffing requirements & Training 4. Reporting Incidients/Pre Licensing Readinessthe state’s words, verbatim · CDSS document, Apr 5, 2024