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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004712
Report Date: 05/29/2025
Date Signed: 05/29/2025 11:45:02 AM

Unsubstantiated


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
02/22/2024 and conducted by Evaluator Bethany Moellers
COMPLAINT CONTROL NUMBER: 22-AS-20240222074546
FACILITY NAME:ADELYA SENIOR HOMEFACILITY NUMBER:
306004712
ADMINISTRATOR:LAWRENCE LINDSEYFACILITY TYPE:
740
ADDRESS:16912 SAGA DRIVETELEPHONE:
(323) 326-9062
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 4DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Larry Lindsey, LicenseeTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal items were stolen from the residents bedroom.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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