Adelya Senior Home

Type of visit: Required - 1 Year

On February 18, 2026, at 8:20 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Imelda Martinez. LPA Kim spoke with Licensee (LI) Lawrence Lindsey over the phone and explained the purpose of the visit. LI Lindsey said they could not attend today’s visit and CG Martinez can sign on their behalf for the report. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: one (1) staff bedroom, four (4) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Martinez. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 105.0 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (657-444-9507) remains available. Emergency food, emergency water, and emergency supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and mounted next to the kitchen. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S3), and medication and medication administration record. LPA observed R1 diagnosed with dementia with a Physician’s report signed and dated on February 14, 2025, R3 diagnosed with dementia signed and dated on August 29, 2022. LPA observed S1 and S2 had their CPR and First aid training expired on March 22, 2025. LPA Kim conducted interviews with two (2) staff and one (1) resident. A deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed S1 and S2 did not have a valid CPR and First aid training at the time of visit. S1's and S2’s CPR and First Aid training expired on March 22, 2025. Technical violation was issued at the time of the visit for R1 and R3 being diagnosed with dementia and not having a current physician’s report. R1’s physician report was dated on February 14, 2025, and R3’s was dated on August 29, 2022. An exit interview was conducted, and a copy of this report, LIC809D, LIC9102, LIC811 and appeal rights were provided to Caregiver Imelda Martinez.the state’s words, verbatim · CDSS document, Feb 18, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Personal items were stolen from the residents bedroom.

On today's date, Licensing Program Manager (LPM) Bethany Moellers delivered complaint findings of the above allegation to Administrator/Licensee, Larry Lindsey. The findings were delivered via phone and emailed for signature. Complainant alleges 2/13/2024 two books of stamps, labels and bank statements were stolen from R1's room while R1 was takinig taking a shower. Licensing Program Analyst Jerome Haley conducted (2) two staff interviews, (3) interviews with outside hospice agency and a resident interview all of which provided no supporting evidence or information that items named were stolen or missing. LPM conducted subsequent interview with Licensee and was informed resident (R1) passed away 5/2024 and staff that was alleged to remove named items is no longer working at the facility for unrelated reasons. Interviews conducted by LPA and LPM were consistant that R1 appeared to be in a confused state of mind. Based on interviews and no additional information to support stolen items the complaint is found to be unsubstantiated. Meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 29, 2025 · control 22-AS-20240222074546

Type of visit: Required - 1 Year

On February 3, 2025, at 9:10am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Imelda Martinez. LPA Kim spoke with Licensee (LI) Lawrence Lindsey over the phone and explained the purpose of the visit. LI Lindsey said they could not attend today’s visit and CG Martinez can sign on their behalf for the report. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: one (1) staff bedroom, four (4) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Ferdinand Baquiran. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 111.8 degrees F to 114.4 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (657-444-9507) remains available. Emergency food, emergency water, and emergency supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and mounted next to the kitchen. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S4), and medication and medication administration record. LPA Kim conducted two (2) staff interviews and one (1) resident interviews. Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed the following deficiencies: 1) The facility did not provide an internet access device that is dedicated for resident use and 2) Resident 4 (R4) has a full bed rail without a hospice care plan and hospice order. Technical violation was issued at the time of the visit. An exit interview was conducted, and a copy of this report and appeal rights were provided to Caregiver Imelda Martinez.the state’s words, verbatim · CDSS document, Feb 3, 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 Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Licensee/Administrator (AD) Lawrence “Larry” Lindsey was contacted via telephone. Adelya Senior Home is a one-story community with five bedrooms and two bathrooms. The facility capacity is 6 and the census was 5 during today’s visit. Residents were observed in their bedroom and in the living room during the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had all the requirements and were in compliance with regulation guidelines. In the resident bathrooms, hot water temperatures were measured in both bathrooms. In bathroom #1 hot water measured at 143.7 degrees Fahrenheit, and in bathroom #2 hot water measured at 139.2 degrees Fahrenheit. No hazardous items were observed in the resident bathrooms. Smoke detectors were observed in resident rooms, the hallway, and living room. The smoke detector in resident room # 1 was not working. All other smoke detectors were operational. One carbon monoxide detector was observed in the hallway near bathroom #1. A fully charged fire extinguisher was mounted on the wall in the kitchen. In the kitchen LPA Haley observed a perishable and nonperishable food supply in compliance with regulation guidelines. Knives and sharp objects are kept locked in a cabinet above the sink. Resident medication, resident files and staff files were locked in a cabinet near the stove. Some hazardous cleaning materials were kept locked in the cabinet above the washer and dryer. The stove was clean and all burners on the stover were non operational. The burners on the stove needed to be lit with a lighter to ignite the flame on the stove. Continued on LIC809C In the hallway, right across from the main bathroom, LPA Haley observed a locked desk with resident medications. In the locked desk/cabinet next to the locked medication desk, there is a locked cabinet with staff and resident files. There was a fully charged fire extinguisher hanging on the wall next to the locked staff and resident files. Down the hallway near the second resident bathroom, a supply of clean linen was observed. Across from bathroom #2, a carbon monoxide detector was observed and right below a fully charged fire extinguisher was mounted on the wall. The garage was used to store a few facility items that are still in good repair. A supply of nonperishable food items was observed in the garage. The cabinet being used to store the nonperishable food items was missing a cabinet door and a red curtain/sheet was being used to cover the missing cabinet door. Photos were taken. The back yard had a shaded patio area with a table and chairs. There was a shed in the back yard that’s used for storage of additional facility items. The back yard was free of tripping hazards clutter and debris. Emergency evacuation drills are conducted quarterly and the first evacuation drill for 2024 has not been scheduled yet. Licensee/Administrator Elizabeth Mullins was consulted on the importance of keeping the facility organized. Administrator Mullins has a lot of supplies and was instructed to keep everything organized and to go through everything and dispose of things not needed to prevent clutter. Deficiencies are being cited as a result of today’s visit. An exit interview conducted and a copy of this report, and appeal rights were provided to Imelda Martinez.the state’s words, verbatim · CDSS document, Feb 20, 2024