Inspection Reports for Adelya Senior Home II
16419 Vernon Street Fountain Valley, CA 92708, CA, 92708
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Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 5
Jul 14, 2025
Visit Reason
An unannounced required continuation annual visit was conducted to evaluate compliance with licensing requirements at the facility.
Findings
The inspection found multiple deficiencies including incomplete annual training for three staff members, missing physician bed rail orders for three residents, incomplete Needs and Appraisal forms for all five residents reviewed, incomplete centrally stored Medication Administration Records, and missing slip mats in three bathrooms which were later provided.
Severity Breakdown
Type B: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Three out of five resident records lacked a written physician order for postural support (bed rails). | Type B |
| Three out of three staff members did not have current required dementia care training completed. | Type B |
| Needs and Services Plans were incomplete for all five resident records reviewed. | Type B |
| Centrally stored medication records and Medication Administration Records were incomplete for all five residents. | Type B |
| Three out of three showers lacked slip-resistant mats at the time of initial inspection. | Type B |
Report Facts
Residents interviewed: 5
Staff interviewed: 1
Resident files audited: 5
Staff files audited: 3
Deficiencies cited: 5
Plan of Correction due date: Jul 22, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eboni Bentley | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Lawrence Lindsey | Administrator | Facility administrator; unable to attend visit but authorized caregiver to sign. |
| Emelda Estrella | Caregiver | Met with Licensing Program Analyst during inspection and received report. |
| Lourdes Montoya | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection. |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 3
Jul 3, 2025
Visit Reason
The inspection was an unannounced required 1-Year annual visit to evaluate compliance with licensing requirements using the CARE Inspection Tool.
Findings
The facility was generally sanitary, appropriately furnished, and maintained a comfortable temperature. However, deficiencies were cited for excessively high water temperatures in resident bathrooms, insufficient emergency food and water supplies, and maintenance issues with stove burners and the kitchen refrigerator.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Water temperatures in three resident bathrooms measured between 132.6 to 138.2 degrees F, exceeding the allowed maximum of 120 degrees F. | Type A |
| Two out of four stove burners were not operational without an external ignitor and the kitchen refrigerator needed repairs. | Type B |
| Insufficient emergency food and water supplies in the garage; only a two-day supply of perishable food and two cases of emergency water were available, with no non-perishable emergency food supply. | Type B |
Report Facts
Capacity: 6
Census: 5
Water temperature: 132.6
Water temperature: 138.2
Emergency food supply: 2
Emergency water supply: 2
Stove burners non-operational: 2
Fire extinguisher purchase date: Jun 16, 2025
Liability insurance effective date: Jul 1, 2025
Liability insurance expiration date: Jul 1, 2026
Administrator certificate expiration: Dec 25, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lawrence Lindsey | Licensee/Administrator | Named in relation to facility operation and plan of correction |
| Eboni Bentley | Licensing Program Analyst | Conducted the inspection and authored the report |
| Imelda Estrella | Caregiver | Met with the Licensing Program Analyst during the inspection and signed report on behalf of Licensee |
| Lourdes Montoya | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Sep 18, 2023
Visit Reason
The Licensing Program Analyst conducted an unannounced visit to complete an annual inspection of the facility.
Findings
The facility was found to be in compliance with all applicable regulations with no deficiencies noted. The environment was safe, well-maintained, and within capacity limits, with proper storage of medications and chemicals, operational smoke detectors, and adequate food supplies.
Report Facts
Residents receiving hospice services: 2
Food supply duration: 7
Food supply duration: 2
Water temperature: 119.8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ruth Martinez | Licensing Program Analyst | Conducted the unannounced annual inspection visit. |
| Lawrence Lindsey | Administrator | Facility administrator mentioned in the report. |
| Imelda Estrella | Caregiver | Greeted the Licensing Program Analyst and accompanied the tour. |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 0
Mar 20, 2023
Visit Reason
Unannounced complaint investigation visit conducted in response to a complaint alleging that the facility is dirty.
Findings
The Licensing Program Analyst conducted a tour, interviews, and record reviews and found the facility to be clean, in good repair, and free of odors. Seven interviews with staff and residents did not corroborate the allegation. No citations were issued, and the complaint was deemed unsubstantiated.
Complaint Details
Complaint alleging the facility is dirty was investigated and found unsubstantiated due to lack of preponderance of evidence.
Report Facts
Residents on hospice: 3
Total interviews conducted: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Celine DePerio | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Lawrence Lindsey | Administrator | Facility administrator who provided consent for staff to receive and sign report |
| Imelda Estrella | Caregiver | Staff on duty who received and signed the report and participated in the facility tour |
| Luz Adams | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 2
Capacity: 6
Deficiencies: 1
Jul 12, 2021
Visit Reason
Licensing Program Analyst Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required annual inspection.
Findings
The facility appeared clean and sanitary with residents well cared for, but unsecured prescription and over-the-counter medications were observed in the unlocked caregiver room, posing an immediate health and safety risk.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Unsecured prescription medications and over-the-counter medications observed in the unlocked caregiver room, posing an immediate health and safety risk to persons in care. | Type A |
Report Facts
Deficiencies cited: 1
Capacity: 6
Census: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kimberly Lyman | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
| Lawrence Lindsey | Administrator | Facility administrator with certificate expiring 12/25/2021 |
| Imelda Estrella | Caregiver | Met with LPA and involved in discussion about findings |
| Alisa Ortiz | Licensing Program Manager | Supervisor of the inspection |
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