Inspection Reports for Adelya Senior Home III
6533 via Estrada Anaheim Hills, CA 92807, CA, 92807
Back to Facility ProfileInspection Report Summary
Most inspections found deficiencies related to resident care, supervision, documentation, and sanitation, with several complaint investigations substantiated. The most serious issues occurred in 2025, including a resident’s unwitnessed fall with delayed medical attention and inadequate supervision, which posed an immediate health risk, and failure to report incidents as required. The facility also had problems with sanitation, maintenance, and access to medical records. The most recent reports from October 7 and 13, 2025, showed that the facility completed required staff in-services and corrected previous deficiencies, indicating improvement. Several complaint investigations were unsubstantiated, and no fines or enforcement actions were listed in the available reports.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 3
Capacity: 6
Deficiencies: 0
Oct 13, 2025
Visit Reason
Licensing Program Analyst Rose Ruppert made an unannounced case management visit to amend a deficiency page from a visit on September 25, 2025.
Findings
The Plan of Correction cited for a Basic Services in-service with staff was completed, and the LIC9099 deficiency page was amended and re-signed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maricel Lindsey | Administrator | Met with Licensing Program Analyst during the visit and involved in exit interview. |
| Larry Lindsey | Licensee spoken to via phone regarding the purpose of the visit and amendment of deficiency page. | |
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Census: 3
Capacity: 6
Deficiencies: 0
Oct 7, 2025
Visit Reason
An unannounced case management visit was made to amend a deficiency page from a prior visit on September 25, 2025, to verify completion of Plans of Correction related to staff in-services and documentation.
Findings
The Plan of Corrections cited on the deficiency page were completed, including staff in-services for 9-1-1 protocols and documentation for change of condition/re-appraisals. An audit of resident files confirmed all required licensing forms were completed.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maricel Lindsey | Administrator | Met with Licensing Program Analyst during the visit and involved in auditing resident files. |
| Larry Lindsey | Licensee spoken to via phone regarding the purpose of the visit and amendment of deficiency page. | |
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 1
Sep 25, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that a resident sustained an unexplained injury while in care due to lack of care and supervision.
Findings
The investigation substantiated that Resident #1 had an unwitnessed fall during the night and was not checked on until the next morning, resulting in delayed medical attention and serious injuries. The facility lacked awake night staff and failed to provide adequate supervision despite knowing the resident was a fall risk.
Complaint Details
The complaint was substantiated. Resident #1 sustained an unexplained injury due to lack of care and supervision. The facility was cited under Title 22, Division 6 of the California Code of Regulations. A civil penalty is pending determination.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate care and supervision as staff placed Resident #1 to bed between 8-9pm on May 12, 2025 and did not check on the resident until May 13, 2025 at 8:15am, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 6
Census: 4
Deficiencies cited: 1
Plan of Correction Due Date: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Maricel Lindsey | Administrator | Facility administrator involved in the investigation and exit interview |
| Lawrence Lindsey | Licensee who was contacted after the resident's fall |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 2
Sep 25, 2025
Visit Reason
The inspection was an unannounced visit conducted for the purpose of completing a Case Management Deficiency related to a complaint investigation (control number 22-AS-20250414124920).
Findings
The facility was found deficient for failing to immediately call 911 after a resident's unwitnessed fall, resulting in a 52-minute delay in medical attention, and for not documenting significant changes in the resident's behavior and fall risk during reappraisal despite knowledge of the resident's wandering behavior, which led to a fall and hospitalization.
Complaint Details
Investigation was conducted for complaint control number 22-AS-20250414124920. The complaint involved a resident's unwitnessed fall and inadequate supervision and documentation by the facility. The deficiencies were substantiated as the facility failed to ensure resident safety and proper documentation.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to immediately call 911 after a resident's fall, causing a delay in medical attention. | Type A |
| Failure to document significant changes in resident's wander behavior and fall risk during reappraisal. | Type A |
Report Facts
Delay in medical attention: 52
Census: 4
Total Capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the unannounced inspection visit and authored the report |
| Alisa Ortiz | Licensing Program Manager | Named in the report as Licensing Program Manager |
| Larry Lindsey | Administrator | Facility Administrator involved in exit interview and cited in findings |
| Maricel Lindsey | Administrator | Facility Administrator involved in exit interview and cited in findings |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 2
Jul 11, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff did not provide access to a resident's record and did not properly sanitize the facility.
Findings
The investigation substantiated that staff denied the Ombudsman access to Resident 1's medical records despite written consent, and that the facility had a strong urine odor, particularly in Resident 2's room, indicating inadequate sanitation and maintenance.
Complaint Details
The complaint was substantiated. Staff denied the Ombudsman access to Resident 1's medical records despite written consent and verbal confirmation from the resident. Staff also failed to properly sanitize the facility, with a strong urine odor observed, especially in Resident 2's room.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to provide access to Resident 1's medical records despite written consent, violating confidentiality regulations. | Type B |
| Facility was not clean or sanitary, evidenced by strong urine odor and warped flooring in Resident 2's room. | Type B |
Report Facts
Capacity: 6
Census: 4
Deficiencies cited: 2
Plan of Correction Due Date: Jul 25, 2025
Plan of Correction Due Date: Aug 8, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Fred Arias | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Maisyarah Sumantri | Facility staff member met during the investigation |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 3
Jun 16, 2025
Visit Reason
The inspection was an unannounced required 1-Year annual visit using the CARE Inspection Tool to evaluate compliance with licensing requirements.
Findings
The facility was found to have unsanitary conditions in the kitchen and bathroom, clutter and toxin storage issues in the garage, and an exit gate in need of repair. Additionally, there were incomplete medical assessments and medication administration records not properly documented for all residents.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Resident #1 has an incomplete Physician's Report with primary diagnosis missing and missing date next to Physician's signature. | Type B |
| Unsanitary conditions observed in the kitchen and bathroom, clutter and storage of toxins with food in the garage, and only one exit gate in the backyard needing repair. | Type B |
| Medication administration records (MAR) were incomplete; medication administered to all residents since 6/6/2025 was not documented. | Type A |
Report Facts
Residents on census: 5
Total licensed capacity: 6
Medication documentation missing since: Jun 6, 2025
POC due date: Jun 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eboni Bentley | Licensing Program Analyst | Conducted the inspection and authored the report |
| Lawrence Lindsey | Administrator | Facility administrator contacted by phone during inspection |
| Connie Martinez | Caregiver | Met with Licensing Program Analyst during inspection and received report copy |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 2
Jun 19, 2024
Visit Reason
Licensing Program Analyst Jerome Haley conducted an unannounced visit to the facility to complete the required Annual inspection.
Findings
The facility was inspected for compliance with regulations including structure, kitchen, medications, resident and staff files, and safety equipment. Citations were issued for deficiencies related to the stove and maintenance issues such as a damaged screen door and cleanliness concerns in the kitchen and bathrooms.
Deficiencies (2)
| Description |
|---|
| The stove is missing knobs and two burners and the warmer will not light unassisted. |
| The screendoor on the sliding door that leads to the back yard is in disrepair with a large hole near the handle. There is oil on the knobs above the stove and several spiders and spider webs were observed in the bathroom near bedrooms. |
Report Facts
POC Due Date: Jun 28, 2024
Residents: 5
Staff Files Reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jerome Haley | Licensing Program Analyst | Conducted the inspection and cited deficiencies |
| Larry Lindsey | Licensee/Administrator | Met with Licensing Program Analyst during inspection and responsible for correction of deficiencies |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 0
Nov 16, 2023
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to get resident medical attention in a timely manner.
Findings
Interviews with the director, staff, resident's son-in-law, and physician confirmed the resident received appropriate medical attention after an unwitnessed fall. The allegation was deemed unfounded as the resident's family decided against sending the resident out for surgery.
Complaint Details
The complaint alleged the facility failed to get resident medical attention in a timely manner. The investigation found the allegation to be unfounded based on interviews and evidence.
Report Facts
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jerome Haley | Licensing Program Analyst | Conducted the complaint investigation visit |
| Maricel Lindsey | Director | Facility director involved in investigation and interviews |
| Luz Adams | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Nov 16, 2023
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 11/08/2023 regarding the facility's failure to report a resident's fall and injury.
Findings
The investigation substantiated that the facility failed to report Resident 1's unwitnessed fall and injury to the Regional Office. Interviews and document reviews confirmed the fall occurred on October 18, 2023, and no incident report was submitted as required by regulations.
Complaint Details
The complaint alleged the facility failed to report a resident’s fall and injury. The allegation was substantiated based on interviews with the Director, staff, Resident 1's son-in-law, physician, hospice provider, and document review.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit a written incident report to the licensing agency within seven days regarding a resident's fall and injury. | Type B |
Report Facts
Capacity: 6
Census: 5
Plan of Correction Due Date: Nov 22, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jerome Haley | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Maricel Lindsy | Director | Interviewed during investigation; confirmed failure to report incident |
| Luz Adams | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Aug 20, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that a resident sustained a pressure injury while in care and that the facility refused medical services for the resident.
Findings
The investigation found that Resident #1 developed a Stage 1 pressure injury and received home health and wound care services as ordered. The allegations were unsubstantiated due to lack of preponderance of evidence that the injury was caused by neglect or refusal of medical services by the facility.
Complaint Details
The complaint was unsubstantiated. Although the allegations may have happened or are valid, there was not sufficient evidence to prove neglect or refusal of medical services by the facility.
Report Facts
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Reed | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Maricel Lindsey | Administrator | Facility administrator met during the investigation |
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