Provider Details - Kelli Samples
712 N KEENE WAY DRIVE
Medford, OR 97504
- Administrator name
- SAMPLES KELLI
- ID
- 525677
- Status
- Open
- Type
- Adult Foster Home
- Classification
- 3
- Licensed beds
- 5
- Accepts Medicaid
- Yes
- Memory Care
- No
If you have questions about this provider or its inspection and compliance history, please contact the provider at the phone number listed above.
This tab displays five years of inspection history.
For inspection information older than five years, please visit
ODHS Records Request
.
To learn more about inspections see:
Provider Information
Records that are highlighted and show the icon, occurred under the current provider owner.
| Date | Event ID | Inspection type(s) Inspection type(s) | Deficiencies cited | Actions | |
|---|---|---|---|---|---|
| 7/23/2026 | MON013136 | Monitoring | 10 | ||
| 11/17/2025 | RL007792 | Re-Licensure | 7 | ||
| 7/9/2025 | MON005378 | Monitoring | 7 | ||
| 1/16/2025 | CPLT002274 | Complaint | 4 | ||
| 11/21/2024 | RL001274 | Re-Licensure | 11 | ||
| 7/23/2024 | F0VZ | Validation | 8 | ||
| 11/16/2023 | QWJS | Validation | 9 | ||
| 10/24/2023 | HB6H | Validation | 8 | ||
| 5/17/2023 | QCKK | Validation | 10 | ||
| 12/8/2022 | SR16 | Validation | 6 |
Records that are highlighted and show the icon, occurred under the current provider owner.
| Date | Report number Report number | Allegation | Level | Type | Actions | |
|---|---|---|---|---|---|---|
| 9/3/2015 | MS152693 | Failed to protect resident from rough treatment | 2 | Abuse: Neglect |
Records that are highlighted and show the icon, occurred under the current provider owner.
| Date | Report number Report number | Allegation | Level | Type | Actions | |
|---|---|---|---|---|---|---|
| 11/17/2025 | CALMS - 00097601 | Failed to provide a safe medication administration system | 3 | Licensing Violation | ||
| 11/17/2025 | CALMS - 00097600 | Failed to provide a safe medication administration system | 3 | Licensing Violation | ||
| 11/17/2025 | CALMS - 00097598 | Failed to provide a safe medication administration system | 3 | Licensing Violation | ||
| 7/9/2025 | CALMS - 00084170 | Failed to provide safe environment | 3 | Licensing Violation | ||
| 7/9/2025 | CALMS - 00084169 | Failed to provide safe environment | 3 | Licensing Violation | ||
| 1/16/2025 | CALMS - 00070797 | Failed to provide safe environment | 3 | Licensing Violation | ||
| 1/16/2025 | CALMS - 00070796 | Failed to provide safe environment | 3 | Licensing Violation | ||
| 11/21/2024 | CALMS - 00068558 | Failed to provide appropriate activities | 3 | Licensing Violation | ||
| 11/21/2024 | CALMS - 00068563 | Failed to keep medication record current or accurate | 3 | Licensing Violation | ||
| 11/21/2024 | CALMS - 00068562 | Failed to keep medication record current or accurate | 3 | Licensing Violation |
| Sanction Sanction | Allegation | Type | Effective date | End date | Actions | |
|---|---|---|---|---|---|---|
| No Results Found | ||||||