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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006217
Report Date: 05/30/2025
Date Signed: 05/30/2025 03:06:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/18/2024 and conducted by Evaluator Carla Martinez
COMPLAINT CONTROL NUMBER: 22-AS-20240618103513
FACILITY NAME:ADLER HEALTHFACILITY NUMBER:
306006217
ADMINISTRATOR:MCPHAIL, ANDREFACILITY TYPE:
772
ADDRESS:275 E. WILSONTELEPHONE:
(310) 909-3400
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:6CENSUS: 0DATE:
05/30/2025
UNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Andre McPhailTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee failed to ensure that planned recreational activities are provided for the clients
Clients records are missing documents such as admission agreements
Facility failed to maintain records verifying that staff meet the minimum requirements for their position
Facility failed to maintain personnel records establishing a sufficient amount of annual in-service training
INVESTIGATION FINDINGS:
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Licensing Program Manager II (LPM) Martinez assisted Licensing Program Analyst (LPA) Ramirez Jr in conducting a complaint investigation into allegations listed above. LPM conducted a review of documents provided to LPA Ramirez Jr. during the initial complaint investigation on June 19, 2024, (which included the following a sample Admission Agreement, Social Skills group notes, Physician Report (LIC 602) for client listed as C1 on LIC811, weekly activity schedule for June 2024, staff In-service training, and resume for three staff (listed as S1, S2 and S3 on LIC811) along with, a review of Department of Health Care Services (DHCS) Title 9 report dated May 23, 2024.
The DHCS report identifies missing records observed during the in-person Title 9 inspection. During an phone interview with licensee McPhail, LPM learned that the facility lost control of property at all three homes licensed under Alder Health LLC. Property owner sold the property and did not disclose to buyers that the homes are licensed Social Rehabilitation Facilities. McPhail is unable to access records from 2024. **Currently there are no clients in care in any of the homes, per McPhail. Orange Regional office will address this matter seperately.**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pam Gill
LICENSING EVALUATOR NAME: Carla Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20240618103513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADLER HEALTH
FACILITY NUMBER: 306006217
VISIT DATE: 05/30/2025
NARRATIVE
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Based on documents obtained and reviewed during investigation, DHCS report and interview with Licensee the allegations of Licensee failed to ensure that planned recreational activities are provided for the clients, Clients records are missing documents such as admission agreements, Facility failed to maintain records verifying that staff meet the minimum requirements for their position and Facility failed to maintain personnel records establishing a sufficient amount of annual in-service training are SUBSTANTIATED.

Findings were discussed with Licensee who has out of State, a copy of this report was emailed to the licensee for signature. Additionally, Licensee will send a copy from the real estate broker to confirm the properties have been sold and a written statement addressing the closure of the three homes will be submitted to LPM Martinez to conclude this investigation.

A plan of correction was developed with the licensee (even though this facility will be closing) which was also sent with appeal rights.

Orange Regional Office will work on closing the three licensed facilities under Alder Health LLC.
SUPERVISORS NAME: Pam Gill
LICENSING EVALUATOR NAME: Carla Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240618103513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ADLER HEALTH
FACILITY NUMBER: 306006217
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2025
Section Cited
CCR
81000(a),B)&(c)
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Social rehabilitation facilities, as defined in Section 80001s.(3), shall be governed by the provisions specified in this chapter. (b) In addition to Section 81000(a) above, social rehabilitation facilities shall be governed by those provisions specified in Title 9
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Should Licensee reapply for licensure they will they review regulations to ensure they are in compliance with ALL applicable laws and regulations (Title 22 and Title (9). Licensee is closing facility and will work with Orange Regional Office to do so.
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(Rehabilitative and Developmental Services), Division 1 (Department of Mental Health), Chapter 3, Article 3.5, Sections 531 through 535 of the California Code of Regulations.
(c) The licensee shall ensure compliance with all applicable law and regulation
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Pam Gill
LICENSING EVALUATOR NAME: Carla Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3