Yellow Rose Assisted Living

Type of visit: Required - 1 Year

On 10/30/2024, at 9:20am, Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced to the facility to conduct the annual inspection visit. LPA met with Licensee Abiy Tesfazgy, announced who he is and the reason for the visit. LPA and Administrator conducted a walking tour of the physical facility. The facility is located in a rural location and has a well for water, sceptic tank for plumbing, and electricity is powered by grid electricity. The front grounds are larger with areas for sitting and tables with covered porch for shade. There are walking areas for the residents in the front of the facility. The backyard is large and enclosed by a fence with self-latching gates on both sides of the yard. The facility has 10-bedrooms, 3 bathrooms, a large kitchen, large living room, dining room. There is a staff office. The facility has battery operated and wired smoke detectors in each room that were inspected by Alpha Fire Inspection on 12/3/2024. LPA observed fire extinguishers throughout the facility that were tagged current and in the green compression range, serviced on 11/20/2024. LPA tested facility hot water at 105*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. During the facility tour in the kitchen at 9:30am LPA noted approximately nine steak knives in the designated knife drawer and the magnetic lock broken and not functioning. At 9:32am LPA observed four lighters in a drawer next to the kitchen sink in an un-lockable drawer. At 9:58am the lockable door to the laundry room was noted to not close completely and the striker not lining up with the strike plate preventing the door from locking. Unlocked chemicals and paint were noted inside the Laundry room. LPA was unable to complete the facility annual and may return at a later date. LPA and Administrator conducted a partial review of the annual care tool modules. Exit interview conducted, deficiency cited on LIC809-D, report signed, and report provided to Administrator.the state’s words, verbatim · CDSS document, Oct 30, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 9:30am on 10/14/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual inspection visit. LPA met with Licensee Abiy Tesfazgy, announced who he is and the reason for the visit. At 10:05am LPA conducted a walking tour of the physical facility. The facility is located in a rural location and has a well for water, sceptic tank for plumbing, and electricity is powered by grid electricity. The front grounds are larger with areas for sitting and tables with covered porch for shade. There are walking areas for the residents in the front for the facility. The back yard is large and enclosed by a fence with self-latching gates on both sides of the yard. The facility is a 10-bedroom, 3 bathroom, large kitchen, large living room, dining room and two day rooms on each side of the facility. There is a staff office. Medications are secured and locked in the pantry closet in the kitchen. The facility has a first aide kit in the pantry that meets regulation requirements. LPA noted that room in the facility all have proper lighting, storage, and linin per regulation standards. LPA noted that the bathrooms have nonskid mats, liquid soap and paper towels. LPA noted that all exits, doors and passageways were free and clear of obstructions. LPA noted smoke detectors working throughout the facility and working carbon monoxide detectors. LPA noted fire extinguisher in the kitchen was currently tagged and in the green range indicating good. LPA noted that the facility was generally clean and in good repair. LPA observed more than 2 days of perishable foods and more than 7 days of non-perishable foods on hand at the facility. LPA noted that Licensee has a current Administrators Certificate that expires on 09/08/2025. LPA reviewed Resident, Staff and Medication records including Infection Control Plan and Emergency Disaster Plan. LPA noted that they found no citations or violations during this annual physical inspection tour. Licensee and LPA competed full care tools review. No other citation or violation was issued during this annual inspection. Exit interview, , report read, and report provided.the state’s words, verbatim · CDSS document, Oct 14, 2024

Allegation investigated: Facility in disrepair.

At 10:00am on 07/11/2024 Licensing Program Analyst (LAP) Jeffries arrived unannounced to the facility to deliver final findings to the allegations to this complaint. LPA met with Licensee, Abiy Tesfazgy, annoucned who he is and the reason for the visit. LPA conducted a coursory tour the the facility. As to the allegation of, “Facility in disrepair.” It was alleged that the facilities kitchen sink, and thermostat for half of the facility's HVAC unit have been inoperable for months. It was discovered through interviews, observation and documentation that on 07/01/2024, LPA Jeffries conducted interviews of 4 of 10 residents. R1- R4 all stated that the facility gets warm, and the administrator provides fans. On 07/01/2024 LPA observed the north side of the facility to be blowing air, however the air was not conditioned to be cold. LPA noted and photographed the thermometer placed on the south side of the facility to be 82* (f) at 10:56am on date of visit. CONTINUED on LIC9099-C Substantiated LPA Jeffries interview with Administrator on 07/01/2024, who indicated that the kitchen sink was recently fixed, and the facilities air conditioner was scheduled to be repaired on 07/03/2024. LPA noted that on 07/05/2024 LPA contacted Administrator by phone to confirm repair. On 07/11/2024 LPA Jeffries conducted a visit to facility to confirm that facility sink and air-condition had be repaired. At this time there is enough evidence to support that during the time of the complaint the facility was in disrepair, therefore the allegation of, “Facility in disrepair.” Is substantiated at this time. Exit interview, report read, appeal rights and report provided. At this time there is not enough evidence to support the allegation of, “Facility staff not using proper infection control practices.” and is unsubstantiated at this time. As to the allegation of, “Facility staff does not provide a good quality of food to residents in care.” It was alleged that the facility does not provide good quality/fresh food. On 07/01/2024, LPA Jeffries interviewed 4 of 10 residents, R1, R2, R3, and R4, who all stated they had no issues with food and no issues with this facility and feel safe and comfortable in this facility. On 10/05/2023 LPA Jeffries conducted full facility annual inspection and observed 2 days of perishable and 7 days of non-perishable foods on hand at the facility for 15 residents and staff. On 07/01/2024 LPA Jeffries interviewed S1 and S2 who stated that the facility administrator has never been short on quality foods. On 06/27/2024 LPA Jeffries conducted an interview of a reliable source [Witness 1, W1] (individual with credential or license to signify expertise in this field.) who visits and observes this facility on a bi-weekly basis. W1 stated that for the last year the facility has had quality foods in sufficient amounts. On 07/01/2024, LPA Jeffries observed at least 2 days of perishable and at least 7 days of non-perishable foods on hand that were of good quality and amounts. At this time there is not enough evidence to support the allegation of. ““Facility staff does not provide a good quality of food to residents in care.” and is unsubstantiated at this time. As to the allegation of, “Facility staff do not meet the needs of resident in care.” It was alleged that the facility is unkept, facility has no activities, and residents have been bitten by fleas. It was discovered through interviews, documentation, and observation that on 07/01/2024 LPA Jeffries interviewed 4 of 10 Residents, R1 -R4 all denied having any bug bites on their bodies. R1 – R4 all stated that staff do a good job of keeping the facility clean. R1- R4 all stated that the facility provides activities daily for all residents. R1- R4 all stated that they had no issues with the facility. On 07/01/2024 LPA Jeffries interviewed S1 and S2, who both stated that facility clean up is a normal party of their daily duties and have never had any issues with completing all daily duties. S1 and S2 deny any indication of residents or staff suffering from any bug bites. On 07/01/2024 LPA Jeffries toured the facility and found the facility to be clean. On 10/05/2023 LPA Jeffries conducted an unannounced annual inspection, and the facility was observed to be clean during that annual inspection. LPA Jeffries reviewed facility weekly activities schedule and noted that activities were observed during annual inspection on 10/05/2023. At this time there is not enough evidence to support the allegation of, “Facility staff do not meet the needs of residents in care.” and is unsubstantiated at this time. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Jul 11, 2024 · control 29-AS-20240626131239

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 11, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors this requiorment was not met by evidence of Air Condition not fuctioning properly for an extened period of time. What places residents in potental danger.the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Licencee agrees to promt repair of failing facility appliances and utilities in a timely manor. .

Type of visit: Case Management - Other

At 9:00am on 07/01/2024, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to address allegations on a separate complaint. Upon screening of care staff, LPA Jeffries discovered that Staff 1 (S1) was not cleared to work at the facility. LPA ran S1 through Guardian, and LIS background checks and did not find S1 on facilities rosters, or by name, date of birth, or social security number in Guardian system. LPA Jeffries requested that S1 leave the facility due to not being a cleared staff. A citation was issued for uncleared staff for the total of the 3 days the staff had been working at the facility. The 3 days of work was verified by interview with S1 and interviews on 07/01/2024 with S2 and S3 during the investigation visit on 07/01/2024. Exit interview, report read, citation and civil penalty issued, appeal rights and report provided.the state’s words, verbatim · CDSS document, Jul 1, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355() · Plan of correction due date: Jul 1, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement was not met by evidence of S1 not being fingerprint cleared to work at this facility, which put Resident in iminate risk.the state’s words, verbatim · CDSS document, Jul 1, 2024

Plan of correction: Licensee agrees to have S1 fingerprint cleared and provide proof of clearance to LPA as soon as S1 has been cleared to work through the fingerprint clearance process. (mark.jeffries@dss.ca.gov)

Allegation investigated: Staff does not ensure that facility has an adequate supply of fresh fruit.

At 10:10am on 10/05/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the initial investigation visit to the allegation to this complaint. LPA met with Licensee Abiy Tesfazgy, announced who he is and the reason for the visit. LPA additionally conducted the annual inspection of the facility on this visit on a separate report. At 10:30am on 10/05/2023, Licensee and LPA conducted a cursory tour of the facility, focused on the kitchen, pantry, and outside storage shed. LPA observed 2 dozen tangerines, 15 bananas, 5 apples, there was ample supply of fresh vegetables, and meats that were refrigerated. LPA observed at least 2 days supply of perishable foods on hand during this cursory tour of the facility. LPA interviewed Staff 1 and Staff 2 (S1, and S2) who stated that the fresh fruit in the facility is stocked daily if needed and at a minimum of every other day. Both S1 and S2 stated that there is always fresh fruit on hand at the facility. LPA interviewed 3 of 9 residents, R1 - 3 stated that this facility has no problems with food supply or variety of foods. R1-3 stated that if they request food or snacks the facility always has provided food and/or snacks at all meal times and whenever they ask for any type of food for alternative to regular meal times. CONTINUED on LIC9099-C Unsubstantiated LPA interviewed Licensee, who stated that the grocery shopping for the facility is done regularly, 3 time per week and as needed. Additionally, fruits and vegetables are often purchased on a daily basis to ensure freshness and quality. As to the allegation of, "Staff does not ensure that facility has an adequate supply of fresh fruit." it was discovered that on approximate date of 10/04/2023, the facility had a low supply of fresh fruit. Licensee stated on 10/05/2023, that supply of fresh fruit (and other perishable and non-perishable foods) was replenished on 10/04/2023, the day of the observed shortage. Licensee stated that on 10/02/2023 was the last time that fresh fruits were purchased (bananas, apples, tangerines, and strawberry's). S1 and S2, interviewed on 10/05/2023 stated the fresh fruit supply is always replenished as soon as it gets low. R1, R2, and R3 stated on 10/05/2023 that they have never had a problems with meals and snack at this facility and feel safe at this facility. LPA observed grocery receipts and collected copies of grocery receipts dated 10/02/2023, and 10/04/2023. Based on interviews, observations, and documentation there is not enough evidence to support the allegation of, " Staff does not ensure that facility has an adequate supply of fresh fruit". and is unsubstantiated at this time. Licensee and LPA discussed the importance of fresh foods including fresh fruits to have on hand for residents at all times and agreed that fresh fruits will always be on hand at this facility at residents request. Exit interview, reportthe state’s words, verbatim · CDSS document, Oct 5, 2023 · control 29-AS-20231004120009

Type of visit: Required - 1 Year

At 10:10am on 10/05/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual inspection visit.. LPA met with Licensee Abiy Tesfazgy, announced who he is and the reason for the visit. LPA additionally conducted a complaint investigation of the facility on this visit on a separate report. At 11:45am Licensee and LPA conducted a walking tour of the physical facility. The the facility is located in a rural location and has a well for water. The well water is tested annual by Miller drilling and the last test was conducted in May of 2023. The front grounds are larger with areas for sitting and tables with umbrellas for shade. The back yard is large and enclosed by a fence with self latching gates on both sides of the yard. The facility is a 10 bedroom, 4 bathroom, large kitchen, large living room, dining room and two day rooms on each side of the facility. There is a staff office. Medications are secured and locked in the pantry colset in the kitchen. The facility has a first aide kit in the pantry that meets regulation requirements. LPA noted that room in the facility all have proper lighting, storage, and linin per regulation standards. LPA noted that the bathrooms have non skid mats, liquid soap and paper towels. LPA noted that all exits, doors and passage ways were free and clear of obstructions. LPA noted smoke detectors working throughout the facility. LPA noted that 1 of 3 carbon monoxide detectors had dead batteries that were replaced during inspection. Licensee stated carbon monoxide detectors will all be replaced by plugin carbon monoxide detectors within 24 hours of this inspection. LPA noted fire extinguisher in the kitchen was currently tagged and in the green range indicating good. LPA noted that the facility was generally clean and in good repair. LPA observed more than 2 days of perishable foods and more than 7 days of non-perishable foods on hand at the facility. And found no citations or violations during he physical inspection tour. Licensee and LPA competed full care tools review. LPA noted that a technical advisory (ta) was issued for the dead batteries in the carbon monoxide detector. And a technical violation (tv) was issued for not reporting current resident under hospice care to Licensing. No other technical, citation or violation was issued during this annual inspection. Exit interview, ta and tv issued, report read, and report provided.the state’s words, verbatim · CDSS document, Oct 5, 2023