Adelya Senior Home Iii

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: -Neglect / Lack of adequate care from staff resulted in resident sustaining multiple pressure injuries. -Staff providing care beyond the scope of the license (wound care). -Staff did not provide resident linens. -Staff did not ensure resident's toileting needs were met. -Staff did not ensure resident was provided daily activities.

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegations listed above. LPA was greeted and granted entry to the facility by Larry Lindsey, Licensee and LPA stated the purpose of the visit. An initial investigation visit was conducted on June 30, 2025. During the visit, LPA Vanegas conducted a tour of the facility, and observed all residents, resting in their respective rooms and the common areas of the facility. LPA Vanegas gathered and reviewed pertinent records pertaining to residents in care in regard to the allegations stated above. LPA Vanegas interviewed one resident as four different residents were not available for interview. Furthermore, LPA Vanegas interviewed the administrator, and three different staff members. Continued on LIC9099-C Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 12, 2026 · control 22-AS-20250627101345

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Resident sustained unexplained injury while in care due to lack of care and supervision

Licensing Program Analyst (LPA) Rose Ruppert conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by staff and explained the purpose of the visit. It was alleged resident sustained unexplained injury while in care due to lack of care and supervision. During the course of the investigation, the Department interviewed staff and witnesses; and subpoenaed and reviewed medical records from the University of California Irvine (UCI) Medical Center. The investigation revealed the following: Resident #1 (R1) was admitted to the facility on April 4, 2025. Per Physician report dated March 25, 2025, R1 had a diagnosis of Dementia. Physician report further assessed R1 had motor impairment/ paralysis, confused and disoriented and was non-ambulatory. (Continued on LIC 9099-C) Substantiatedthe state’s words, verbatim · CDSS document, Sep 25, 2025 · control 22-AS-20250414124920

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff did not provide access to a resident's record Staff did not properly sanitize the facility

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to conduct an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged staff did not provide access to a resident's record and staff did not properly sanitize the facility. During the investigation, LPA conducted interviews with staff and residents in care and reviewed records obtained. The investigation determined as follows: Regarding the allegation staff did not provide access to a resident's record, it was reported the facility did not allow the visiting Ombudsman access to Resident 1 (R1)'s medical record even though the Ombudsman had obtained written consent from R1 on June 30, 2025. LPA interview with R1 stated they provided consent to the Ombudsman. LPA showed a copy of the signed consent form to R1 and R1 confirmed they signed the consent form. Continued on 9099-C dated 07/11/2025 Substantiatedthe state’s words, verbatim · CDSS document, Jul 11, 2025 · control 22-AS-20250706214148

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Facility failed to report resident’s fall and injury.

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received November 8, 2023. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Director Maricel Lindsy was contacted via telephone and arrived shortly after and was present for the remainder of the visit. Regarding the allegation: Facility failed to report resident’s fall and injury. During an interview with Director Lindsy it was confirmed no incident report was sent to the Region Office regarding Resident 1's fall and injury. Interviews with Director Lindsy, facility staff, Resident 1's son-in-law, R1's physician, and hospice provider confirmed R1 had an unwitnessed fall and sustained an injury to the hip. A review of Angels Hospice RN/LVN Communication Flow Sheet revealed R1 fell on October 18, 2023. Based on the evidence gathered through interviews, and document review the preponderance of evidence standard has been met, therefore, the abovthe state’s words, verbatim · CDSS document, Nov 16, 2023 · control 22-AS-20231108125250

Allegation investigated: Facility failed to get resident medical attention in a timely manner.

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received against this facility on November 8, 2023. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Director Maricel Lindsy was contacted via telephone and arrived shortly after and was present for the remainder of the visit. Regarding the allegation: Facility failed to get resident medical attention in a timely manner. Interviews with Director Lindsy, facility staff, Residents 1 (R1) son-in-law, and R1’s physician revealed R1 received the appropriate medical attention after an unwitnessed fall. The day of the fall, staff contacted Director Lindsy and Angels Hospice. Director Lindsy contacted R1’s son-in-law regarding the unwitnessed fall. During an interview with R1 son-in-law, he confirmed he was notified of the fall immediately. Angels Hospice confirmed they came to assess the resident after the fall, and a doctor came to Xray R1’s hip wthe state’s words, verbatim · CDSS document, Nov 16, 2023 · control 22-AS-20231108125250