Adriana Elderly Care Home I

Allegation investigated: Staff did not turn resident every hour. Staff refused resident medical attention. Staff confiscated resident's personal items. Staff did not allow resident phone calls.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility to complete the investigation and deliver findings on the allegations listed above. LPA was greeted and granted entry by staff after explaining the reason for the visit. The complaint investigation consisted of interviews and document review. Regarding the allegation: Staff did not turn resident every hour 10 of 10 individuals failed to provide any corroborating information or evidence to support the complaint allegation. Just about everyone interviewed said Resident 1 (R1) is rotated or repositioned every two hours. According to one individual, R1 is rotated between 6-8 times a day. According to the Executive Director (ED) Richard Mendoza, R1 is not bed-bound, but the resident needs assistance repositioning every two hours. According to ED Mendoza, assistance with repositioning is documented on R1 care plan. Continued on LIC9099C Unsubstantiated Regarding the allegation: Staff refused medical attention. 10 of 10 individuals failed to provide any corroborating information or evidence to support the complaint allegation. According to ED Mendoza, R1 was sent to the hospital at the recommendation of a physician after a routine doctor's appointment. ED Mendoza explained an incident when R1 was taken to the hospital after a friend of R1 called 911. When the paramedics arrived to transport the resident, no one knew what was going on because the friend called 911 from outside the facility and did not notify facility staff about the reason for the call. R1 was eventually sent to the hospital after paramedics assessed the resident. Document review revealed R1 did receive medical care and attention as there were several Kaiser discharge summary’s for medical treatment R1 received. Regarding the allegation: Staff confiscated residents personal items. 10 of 10 individuals failed to provide any corroborating information or evidence to support the complaint allegation. It is unclear what exactly was confiscated from R1, but the resident denied the complaint allegation. R1 denied anyone confiscated their personal belongings. All facility staff who were interviewed denied any items were confiscated. Two witnesses also provided information that contradicts the complaint allegation. One witness stated R1 is safe and another witness stated R1 is fine and there are no concerns with the care at the facility. Regarding the allegation: Staff did not allow the resident phone calls. 10 of 10 individuals failed to provide any corroborating information or evidence to support the complaint allegation. R1 denied the allegation. According to multiple interviews, no on is restricted from using the phone, but residents do not use the phone because they all have their own phone. One individual who was interviewed, claims no one has been denied the opportunity to use the phone, but stated it’s rare that any residents want to use the phone because all the residents have their own phone. Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance to prove or refute the alleged violations occurred; therefore, the allegations are deemed Unsubstantiated.the state’s words, verbatim · CDSS document, Jul 16, 2026 · control 22-AS-20230303155354

Type of visit: Case Management - Deficiencies

During the investigation into complaint control number 22-AS-20230303155354 it was discovered the facility forgot report when Resident 1 (R1) was hospitalized. While investigation the complaint control number above, it was discovered and confirmed R1 was sent to the hospital at least three times. Document review revealed R1 was sent to the hospital more that three times and no incident reports were sent to the Regional Office. There was also an uncleared and unassociated individual present when LPA Haley arrived to deliver findings on the complaint control number above. Executive Director (ED) Mendoza confirmed the individual was being screened for possible employment and only been working a couple days. As a result of today’s Case Management visit, deficiencies will issued. An exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 16, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jul 17, 2026

87355 (e)(3) - Criminal Record Clearance All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355... This requirement is not being met as evidenced by: Unidentified Individual 1 (UI1) was present in the facility upon LPA’s arrival. It was confirmed with Executive Director Mendoza UI1 did not have a criminal record clearance as the individual’s cleaning work was being reviewed and permanent employment was pending.the state’s words, verbatim · CDSS document, Jul 16, 2026

Plan of correction: UI1 exited the facility and will not be allowed to work in the facility until fingerprint cleared and associated to the facility roster. Executive Director Mendoza will email LPA Haley once UI1 is fingerprint cleared and associated to the roster.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Jul 22, 2026

87211 Reporting Requirements (a) Each licensee shall furnish... such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days... This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: The facility forgot to report multiple hospitalization's/ER visits for R1 including when R1 was sent to the hospital before eventually passing away at the hospital at the end of December 2023 or early January 2024.the state’s words, verbatim · CDSS document, Jul 16, 2026

Plan of correction: Executive Director Mendoza agrees to review Reporting Requirements and will email LPA Haley when the regulation section has been read and understood. ED Mendoza will also inform LPA Haley who will be responsible for reviewing and submitting all incident reports to the Regional Office according to regulation guidelines.

Type of visit: Collateral

On February 9, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced Collateral visit to the facility. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Direct Care Staff (DCS) Ariande Salazar notified Administrator Kevin Mendoza, who later arrived to assist with today's visit. The Collateral visit is being conducted in conjunction with complaint 22-AS-20251203153959 for the previous facility resident resided at. Resident moved into Adriana Elderly Care Home I on October 10, 2025. During today's visit, LPA accompanied by the Administrator, conducted a tour of the physical plant of the facility. LPA observed the facility to be clear of any hazards. No health or safety concerns were observed. LPA conducted resident and staff interviews. LPA additionally collected pertinent documents to the complaint such as the resident records and contact information of hospice agency. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Kevin Mendoza and a copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Johanna Reyes after stating the reason for the visit. Administrator (Admin) Richard Mendoza arrived on premise approximately 8:45am and remained at the facility to assist with the inspection. Admin has a valid administrator's certificate expiring on September 7, 2026. The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of six resident bedrooms, one staff bedroom, and four resident bathrooms. Facility operates within the conditions and limitations specified on the license. LPA observed five residents in care of which two are receiving hospice services. LPA observed two caregivers on duty and verified fingerprint clearance and association statuses including the administrator. LPA along with Caregiver Reyes toured the interior portion of the facility. All common areas were inspected which includes the attached two car garage. The fireplace is appropriately screened in the living room. LPA inspected all the resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be in compliance, clean, and operational. Slip resistant mats were available. The hot water temperature in the bathrooms measured at 110.3, 107.6, 107.0, and 107.6 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The two exit gates on each side of the property are operational, and there were sufficient seating and shading in the patio area. The fire extinguisher was mounted, charged, and serviced on March 12, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Facility maintains emergency food and water in the kitchen pantry. The first aid manual and first aid kit had all necessary elements. LPA reviewed five out of five resident files and two personnel files in which no discrepancies were found. Medications were audited for two out of six residents and no discrepancies were found. Based on the observations made during today's visit, no deficiencies are being cited. An Advisory Note is being issued. An exit interview was conducted with Administrator Richard Mendoza, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Dec 18, 2025

The state marks this report as 4 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

Licensing Program Analysts (LPAs) Ruth Martinez and Nancy Guillen are conducting this unannounced visit for the purpose of completing an annual required inspection. LPAs arrived at the facility and were greeted and granted entry by staff. Kevin Mendoza and Richard Mendoza, Administrators arrived shortly after and LPAs explained the nature of the visit. There are five residents at the facility and there are three residents receiving hospice services currently. LPAs accompanied with Administrators began the tour of the inside and outside of the facility. LPAs observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. The facility is maintained at a comfortable temperature. LPAs inspected that medication is centrally stored in a locked storage closet located in the entry way between dinning room and living room. LPAs reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPAs inspected the bathroom and LPAs measured the hot water temperature which measured 119.2 degrees Fahrenheit. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the garage. The facility has an available clean supply of linens. LPAs inspected residents’ bedrooms which have sufficient lighting to ensure the safety and comfort of residents. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPAs toured the outside of the facility and observed outdoor passageways are free of obstructions. LPAs observed there are shaded seating areas for residents’ enjoyment. LPAs observed a fire extinguisher with service date of March 13,2024, in kitchen. Continued on LIC809-C LPAs began review of records. LPAs reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPAs reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPAs observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Dec 11, 2024