Provider Details - Kellyville RCF | Licensed Long-Term Care Settings Search

Kellyville RCF

12221 SE KELLY STREET
Portland, OR 97236

(503) 954-2561
maricel@kellyvillercfpdx.com

Administrator name: Maricel Asa

ID: 50R454
Status: Open
Type: Residential Care Facility
Licensed beds: 50
Accepts Medicaid: Yes
Memory Care: No

Owner: Ysa Group Operating Company, LLC

13695 SE ELLEN DRIVE
Clackamas, OR 97015

(503) 805-0677

Owner since: 12/12/2017

If you have questions about this provider or its inspection and compliance history, please contact the provider at the phone number listed above.

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Licensing inspections evaluate a provider’s compliance with rules and laws. Licensing surveyors look at a variety of factors, including quality of care and services provided, as well as the condition of the provider’s physical structure, equipment, staffing levels, policies, procedures and finances. Under federal requirements, nursing facilities receive recertification inspections and inspections following a complaint investigation. The inspections represent a snapshot of the provider’s compliance with regulatory requirements at the time the inspection took place.

Records that are highlighted and show the icon, occurred under the current provider owner.

Provider Details - Kellyville RCF
Date Date From To	Event ID	Inspection type(s) Inspection type(s)	Deficiencies cited Deficiencies cited Between And
8/11/2025	YI2X	Complaint Investig.	2
6/3/2025	KIT004770	Kitchen	1
11/6/2024	RL001097	Re-Licensure	12
4/4/2024	IQEY	State Licensure	0
5/4/2023	8784	State Licensure	0
1/20/2023	T0LL	Complaint Investig.	3
11/15/2021	4R8T	Validation	18

7 records found

This list shows confirmed (substantiated) instances of abuse from 2010 onward. Open investigations and complaints that are being appealed by the provider are not listed. To learn more about abuse definitions, see: Definitions of Abuse

Records that are highlighted and show the icon, occurred under the current provider owner.

Provider Details - Kellyville RCF
Date Date From To	Report number Report number	Allegation Allegation Failed to administer medication as ordered Failed to protect resident from mental or emotional abuse Failed to provide a safe medication administration system Failed to provide or maintain resident care equipment Failed to provide peri care Failed to provide safe environment Failed to provide service	Level Level Between And	Type Type Abuse: Neglect
5/13/2022	00209514-AP-169331	Failed to provide service	2	Abuse: Neglect
11/12/2020	00111977-AP-086346	Failed to protect resident from mental or emotional abuse	2	Abuse: Neglect
3/21/2020	00076948-AP-056847	Failed to provide peri care	2	Abuse: Neglect
3/21/2020	00077117-AP-056926	Failed to provide peri care	2	Abuse: Neglect
3/21/2020	00077120-AP-056927	Failed to provide peri care	2	Abuse: Neglect
3/21/2020	00077121-AP-056928	Failed to provide peri care	2	Abuse: Neglect
3/13/2020	00077769-AP-057530	Failed to provide safe environment	2	Abuse: Neglect
10/16/2019	00055347AP-039033	Failed to provide a safe medication administration system	2	Abuse: Neglect
9/29/2019	00055794AP-039255	Failed to administer medication as ordered	2	Abuse: Neglect
6/11/2018	00006992AP-005309	Failed to provide or maintain resident care equipment	2	Abuse: Neglect

10 records found

This list shows confirmed (substantiated) licensing violations from 2010 onward. Open investigations and complaints that are being appealed by the provider are not listed.

Records that are highlighted and show the icon, occurred under the current provider owner.

Provider Details - Kellyville RCF
Date Date From To	Report number Report number	Allegation Allegation Failed to administer medication as ordered Failed to assure resident rights Failed to hire according to administrative rules Failed to maintain a safe physical environment Failed to meet the scheduled and unscheduled needs of residents Failed to properly post and maintain daily staffing documentation Failed to protect resident from verbal abuse Failed to provide appropriate housekeeping services Failed to provide appropriate staffing Failed to provide proper food/nutrition Failed to provide safe environment Failed to report potential or suspected abuse Failed to submit timely or adequate staffing documentation Failed to update staffing plan based on ABST Failed to use an ABST	Level Level Between And	Type Type Licensing Violation
5/22/2025	CALMS - 00086312	Failed to meet the scheduled and unscheduled needs of residents	2	Licensing Violation
3/10/2023	OR0004098300	Failed to update staffing plan based on ABST	2	Licensing Violation
3/10/2023	OR0004098301	Failed to use an ABST	2	Licensing Violation
12/1/2022	OR0003906600	Failed to assure resident rights	2	Licensing Violation
6/1/2022	CALMS - 00028941	Failed to submit timely or adequate staffing documentation	2	Licensing Violation
4/8/2022	OR0003520200	Failed to administer medication as ordered	2	Licensing Violation
1/13/2022	00179007-AP-142428	Failed to protect resident from verbal abuse	2	Licensing Violation
6/7/2021	OR0003035700	Failed to provide safe environment	1	Licensing Violation
6/7/2021	OR0003035701	Failed to provide appropriate staffing	1	Licensing Violation
12/25/2020	OR0002779400	Failed to provide safe environment	1	Licensing Violation

19 records found | Page 1 of 2

Formal regulatory actions can range from a condition placed upon a license due to non-compliance or a notice to revoke a license. This section of the website currently displays only license conditions dating back to 2010 and no other types of regulatory action. Additional records will be added over time as resources allow.

Records that are highlighted and show the icon, occurred under the current provider owner.

Provider Details - Kellyville RCF
	Sanction Sanction	Allegation Allegation Failed to staff as indicated by ABST	Type Type License Condition	Effective date Effective date From To	End date End date From To	Actions
	RCFCD23-00268	Failed to staff as indicated by ABST	License Condition	3/1/2023	1/22/2024

1 record found

The Oregon Department of Human Services publishes annual reports about assisted living and residential care facilities, including those with memory care endorsements. The reports show how facilities are doing in areas like staffing, safety, and resident experience.

Facilities submit this information once each year using an online reporting tool. The results reflect how each facility operated during that year. The information is self-reported by facilities and is not independently audited by the department. This means the reports show what facilities report about their own performance.

Each year, assisted living and residential care facilities must report information on:

Retention of direct care staff
Compliance with staff training requirements
Number of resident falls that result in injury
Incidence of use of antipsychotic medications for non-standard purposes
Results of an annual resident satisfaction survey conducted by an independent entity

Facilities submit this information electronically each year. Reporting began in 2020. Instructions and definitions are updated annually and published on the Residential Care Quality Metrics Program web page

Provider Details - Kellyville RCF

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Provider Details - Kellyville RCF

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