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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880507
Report Date: 08/14/2025
Date Signed: 08/14/2025 02:44:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250707101954
FACILITY NAME:YELLOW IRIS RESIDENTIAL CAREFACILITY NUMBER:
361880507
ADMINISTRATOR:OSBY, TAMMYFACILITY TYPE:
735
ADDRESS:7666 YELLOW IRIS COURTTELEPHONE:
(909) 346-0392
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:4CENSUS: 2DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Faciliity Licensee/Administrator Tammy OsbyTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff illegally evicted a resident in care.
Staff did not seek medical attention in a timely manner.
INVESTIGATION FINDINGS:
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On 8/14/2025 Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Licensee/Administrator Tammy Osby and explained the purpose of the visit. The investigation consisted of staff interviews, outside parties interviews and record reviews.

First Allegation: Staff illegally evicted a resident in care.

For the allegation, Staff illegally evicting a resident in care is an improper eviction which does not follow the eviction procedures of facility’s inability to meet the client’s needs. Licensee has provided the client#1 and their family an eviction notice but needs and services plan modification has not been performed to determine that client needs cannot be met by the facility. According to Inland regional center (IPP) report Client#1 behaviors have noticeably decreased from July 2024 to July 2025, as shown by the numbers total of 181 behaviors in July 2024 to 39 in July 2025, which indicates that this home/facility is still an appropriate placement for Client#1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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 56-AS-20250707101954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: YELLOW IRIS RESIDENTIAL CARE
FACILITY NUMBER: 361880507
VISIT DATE: 08/14/2025
NARRATIVE
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Based on observations, interviews, record reviews, and the totality of evidence gathered, there is sufficient evidence to support the allegation. The preponderance of evidence standard has been met, leading to the substantiated finding of Staff illegally evicting a resident in care.

Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 85068.5(4), from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.

Second Allegation: Staff did not seek medical attention in a timely manner.

For the allegation, Staff did not seek medical attention in a timely manner, the investigation consisted of interviews of facility staff and outside parties. LPA requested copies of pertinent facility file documents. Staff and records reviews revealed licensee failed to seek medical attention in a timely manner. On 5/21/25 Client#1(C#1) family noticed discoloration underneath the toenail and pointed out to the licensee, on 5/24/25, family sent a follow-up message to inquire about any treatment being sought, which developed into an infection, medical treatment was not sought by the facility staff until the day on 5/29/25, when primary care provider asked the staff/Licensee to take C#1 for immediate medical attention to urgent care where C#1 received antibiotics and a week of treatment to follow up with a podiatrist.

Based on observations, interviews, record reviews, and the totality of evidence gathered, there is sufficient evidence to support the allegation. The preponderance of evidence standard has been met, leading to the substantiated finding of Staff did not seek medical attention in a timely manner.

Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 85075 (b), from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.


An exit interview was conducted, and this report (LIC9099) LIC 9099C, LIC9099D and Appeal Rights were discussed and provided to Licensee/Administrator Tammy Osby
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20250707101954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: YELLOW IRIS RESIDENTIAL CARE
FACILITY NUMBER: 361880507
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
08/15/2025
Section Cited
CCR
85068.5(4)
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85068.5 Eviction Procedures
(4) A needs and services plan modification has been performed, as specified in Section 85068.3, which determined that the client's needs cannot be met by the facility.
This requirement is not met as evidence by:
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Licensee/Administrator will read over regulation and provide a same day written statement indicating the acknowledgement and review of the regulation. Licensee/Administrator Tammy Osby will send a copy of this signed statement to LPA by Plan of Correction due date.
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Based on interviews, observation and record review, the licensee did not ensure that the licensee followed eviction procedures which poses an immediate Health, Safety or Personal Rights risk to persons in care.
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Plan Of Corrections due date-8/15/2025.
Type A
08/15/2025
Section Cited
CCR
85075(b)
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Health Related services. The facility shall develop and implement a plan which ensures that assistance is provided to the clients in meeting their medical and dental needs.

This requirement is not met as evidence by:
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The licensee shall ensure immediate medical attention is obtained for clients as warranted. The licensee/ administrator Tammy Osby send a written plan of correction.
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Based on interviews, record review, the licensee did not ensure Health RElated Services were provided, which poses an immediate Health, Safety, or Personal Rightes risk to person in care.
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Plan Of Corrections due date-8/15/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3