Adelya Senior Home II

Type of visit: POC

Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct a Plan of Correction (POC) inspection for a deficiency that was cited during the required annual inspection on July 21, 2026. LPA was greeted and granted entry by staff. LPA met with Caregiver Jimmy Estrella and discussed the purpose of the visit. Caregiver Jimmy Estrella called Administrator Lawrence Lindsey and informed them of LPAs presence and assisted by phone. LPA toured the facility and observed residents in care relaxing and watching tv. LPA observed that an operational carbon monoxide detector was located in the facility hallway. Based on today's inspection no deficiencies were noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and POC clearance letter was left at the facility.the state’s words, verbatim · CDSS document, Aug 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Caregiver (CG) Imelda Estrella. CG contacted Licensee Lawrence Lindsey by phone and informed them of LPAs presence in the facility. Licensee informed CG that they were unable to come to the facility but could assist by phone. The facility is a one story home with two living rooms, a dining room, kitchen, three bathrooms, five resident bedrooms, one staff bedroom and attached two car garage. LPA observed the resident bedrooms had all the required components and furnishings. LPA observed 4 of 5 residents to have bedrails on their beds without bed rail orders on file. LPA observed the staff bedroom to be locked and made inaccessible to residents in care. LPA observed the bathrooms to have toilet paper and textured shower flooring. LPA tested the water to be between 114.4 and 115.3 degrees Fahrenheit. LPA observed the kitchen to have working appliances with a two day perishable and seven day non perishable food supply on hand. LPA observed the knives to be in a locked drawer by the stove, making them inaccessible. LPA observed toxins and chemicals to be under the locked kitchen and bathroom sink, making them inaccessible to residents in care. The centrally stored medication is stored in a locked closet located in the kitchen. The first aid kit had all the required components. LPA observed the garage to be used as extra facility storage with a working fridge and freezer. The garage is also used as an extra space for staff to take their breaks in. LPA observed a fire extinguisher in the hall by the garage door to have a purchase date of February 1, 2026. The backyard did not have any debris or obstructions. A shaded seating area was observed for resident use. CG tested the fire alarms and they were found to be operational. A carbon monoxide detector was not located in the facility. Continue on LIC809C LPA reviewed staff files and no discrepancies were observed. LPA reviewed resident files and no discrepancies were observed. LPA reviewed resident medications and was unable to review a completed MAR for 4 of 4 residents and observed 2 of 4 residents have over the counter medications without a physicians order on file. LPA reviewed that the last disaster drill was conducted on April, 1, 2026. All staff present are background cleared and associated to the facility. Licensee informed LPA that the Administrator of the facility is Maricel Lindsay. LPA observed they have an active Administrators certificate with an expiration date of March 3, 2028. LPA advised Licensee to send in documentation to update the facilities administrator. Based on today’s inspection, technical violations and deficiencies were noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC 809D, Technical violation, records reviewed and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 21, 2026

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Staff kicked resident.

On March 16, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of conducting an initial complaint investigation and deliver findings for the above allegation. LPA was greeted, introduced self, and was granted entry after stating the purpose of the visit to staff. Administrator Larry Lindsay was contacted via telephone, LPA stated the purpose of the visit, and Administrator granted permission for Caregiver Jimmy Estrella to sign the report. During the course of the investigation, LPA reviewed and obtained copies of facility documents including: Resident Roster, Staff Roster, Resident Emergency Info & Contact Sheets, Physician's Reports, Personal Rights, and Needs and Services Plan for Resident #1 (R1). Interviews were successfully conducted with three residents, one staff, and two witnesses. CONTINUE TO LIC9099-C..... Unsubstantiated Regarding the allegation, staff kicked resident, it is alleged that an altercation occurred between a resident and staff. It was reported that Resident 1 (R1) kicked Staff 1 (S1) and S1 kicked R1 back. Based on record review of admission agreement, R1 was admitted to the facility on September 3, 2025. The Physician’s Report for R1, dated September 3, 2005, states R1 was diagnosed with a brain tumor, stoke, has memory loss, and expresses frustration with the inability to do things on their own. Five out of seven individuals interviewed denied the allegation. During interviews conducted, Witness 1 (W1) and Witness 2 (W2) stated staff are always nice to residents and respond promptly. W1 & W2 stated they have never observed staff being physically or verbally abusive to any residents in care. Two out of three residents interviewed denied the allegation, stating staff take good care of them and are always nice. One resident stated they are frustrated with not being able to do things they are used to doing, including getting out of bed and walking around the facility. All staff interviewed denied the allegation, stating R1 often gets upset and forgets how incidents occurred due to diagnosis. S1 stated R1 sometimes gets verbally and physically aggressive, however S1 denies ever kicking R1, stating they take a breaks whenever necessary but do not react to R1’s behavior. During an interview with R1, the resident admitted getting facts mixed up when recalling how previous incidents occurred. R1 stated they often move around the bed to get comfortable and sometimes prop their legs up against the bed rails. R1 stated they may have hit their leg on the bed rail but is not always clear about how things occurred. Based on observations made, interviews that were conducted, and records reviewed, this Department did not find sufficient evidence to support the above allegation Staff kicked resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with staff and a copy of the report provided at exit.the state’s words, verbatim · CDSS document, Mar 16, 2026 · control 22-AS-20260310175337

Type of visit: Case Management - Deficiencies

On March 16, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted a case management deficiency visit after observing a deficiency while conducting complaint visit: 22-AS-20260310175337. During a tour of the facility with staff, LPA observed a strong urine smell when entering R1's room. Per interview conducted with Staff #1 (S1), staff confirmed the urine smell and stated it was coming from the commode located in R1's bedroom. S1 stated it always smells this way and staff cannot get rid of the smell. A deficiency was cited by Title 22 Division 6 Chapter 8. An exit interview was conducted with staff, and a copy of this report, LIC809-D, LIC811, and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 16, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 23, 2026

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview, a strong urine odor was observed in one out of the five residents bedrooms and one staff corroborated that the urine smell is coming from the commode, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2026

Plan of correction: Licensee stated there will be a deep of resident's bedroom, will replace commode and will submit prood of CCLD/LPA via email by POC due date.

Type of visit: Case Management - Annual Continuation

On July 14, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required continuation annual visit. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Imelda Estrella. LPA 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 Estrella can sign for the report on their behalf. LPA Bentley toured inside and outside of the physical plant with CG Estrella. The resident bedrooms were inspected and contained all the required elements. Bathrooms were found to be clean and operational, however, there were no slip mats available at the time of the initial tour. During today’s visit, interviews were conducted with five (5) residents and one (1) staff during today’s visit. Medication and Medication Administration Record (MAR) reviewed. LPA Bentley conducted an audit of five (5) resident files (R1-R5) and three (3) staff files (S1-S3). Based on observation, interview, and record review, licensee did not ensure annual training was complete/up-to-date for three staff members, three residents do not have bed rail orders on record, Needs and Appraisal forms are incomplete for five residents, Centrally Stored Medication Administration Record is incomplete, Slip mats were missing in three bathrooms and later provided. Based on today’s observations, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted and a copy of this report, LIC809-D, Technical Violations, and appeal rights were provided to Caregiver (CG) Imelda Estrella.the state’s words, verbatim · CDSS document, Jul 14, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On July 3, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Imelda Estrella. LPA 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 Estrella can sign for the report on their behalf. The facility is licensed to operate for six (6) non-ambulatory, of which one (1) may be bedridden, with a hospice waiver for three (3) residents. The home consists of 5 resident bedrooms, 1 staff bedroom, 3 bathrooms, living room, dining room, and kitchen. LPA Bentley toured inside and outside of the physical plant with CG Estrella. There were no bodies of water or obstructions on the premises. A comfortable temperature of 76 degrees F was maintained 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 bedrooms were inspected and contained all the required elements. Bathrooms were found to be clean and operational. The water temperature measured between 132.6 to 138.2 degrees F. A deficiency was cited for water temperatures in bathrooms used by residents in care. CONTINUE TO LIC809-C PAGE.. LPA Bentley observed the facility to be sanitary and 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 available and maintained properly. Emergency safety drills was last conducted on June 15, 2025 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. During the visit, LPA Bentley observed the smoke detectors and carbon monoxide detectors were operable. A working telephone (657-218-46-80) remains available. The facility has one (1) fire extinguisher that was charged, mounted in the hallway, with a purchase date of June 16, 2025. Liability Insurance is effective 7/1/2025 and expires on 7/1/2026. The facility does not have a sufficient amount of emergency food and emergency water stored in the garage. A deficiency was cited. Licensee/Administrator Lawrence Lindsey has an administrator certificate that expires on December 25, 2025. Based on observations, deficiencies are being cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, a copy of this report, LIC809D and appeal rights were provided to Caregiver Imelda Estrella.the state’s words, verbatim · CDSS document, Jul 3, 2025