306001851-1-26-2026-22-AS-APAO-DQS4K8-20260128180951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001851
Report Date: 01/26/2026
Date Signed: 01/26/2026 01:50:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/24/2021 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210824152139

FACILITY NAME:	KATHRYN JANE RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	306001851
ADMINISTRATOR:	ALFONSO/EDILMA AVENDANO		FACILITY TYPE:	740
ADDRESS:	26861 VIA GRANDE		TELEPHONE:	(949) 632-3762
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 4	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Edilma Avendano		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Facility staff do not accord resident privacy during therapy sessions
Facility staff speak inappropriately to resident
Facility staff do not treat resident with dignity

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Staff #1 (S1) Edilma Avendano and explained the reason for today’s inspection.

The investigation into the allegations that facility staff do not accord resident privacy during therapy sessions, facility staff speak inappropriately to resident, and facility staff do not treat resident with dignity revealed the following: During the course of the investigation, LPA inspected the facility, interviewed Administrator (AD) Alfonso Avendano, staff, witnesses, and residents, and obtained and reviewed copies of the resident roster, staff roster, and resident vaccination records.

CONTINUED

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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-20210824152139

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KATHRYN JANE RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 306001851
	VISIT DATE: 01/26/2026

NARRATIVE

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Regarding the allegation that facility staff do not accord resident privacy during therapy sessions: it was alleged that AD demanded to know the details of R1’s confidential sessions with their therapist, engaged in inappropriate behavior with R1’s therapist when they refused to share confidential information with AD, and has made it difficult for R1’s therapist to conduct private therapy sessions with R1 at the facility. LPA interviewed AD who denied the allegation, stating that R1’s therapy sessions are private, AD has not received any confidential information, and AD has never tried to interfere with these therapy sessions or invade R1’s privacy. Per AD, they did try to coordinate with R1’s therapist regarding R1’s mental health for the purpose of helping to support R1, but R1’s therapist refused and AD accepted their response. LPA interviewed S1 who was unable to provide information regarding the allegation. LPA interviewed one additional staff who did not corroborate the allegation. LPA interviewed R1 who was unable to provide information regarding this allegation. LPA interviewed the four other residents who did not report any concerns at the facility. LPA interviewed R1’s responsible party who was aware of the reported concerns regarding R1’s therapy sessions, was unable to provide additional information, and stated that their only concern is that they had a disagreement with AD regarding the use of medications to treat R1’s mental health concerns.

Regarding the allegation that facility staff speak inappropriately to resident: it was alleged that AD provided misinformation and spoke extensively about their negative personal opinions on vaccines, instilling fears in R1 and other residents. LPA interviewed AD who denied the allegation, stating that all residents were vaccinated for COVID-19, they did not try to stop residents from getting vaccines, and they did not make anti-vaccine remarks to residents. LPA reviewed resident vaccination records which confirmed that all residents received COVID-19 vaccinations. LPA interviewed S1 who was unable to provide information regarding the allegation. LPA interviewed one additional staff who did not corroborate the allegation. LPA interviewed R1 who was unable to provide information regarding this allegation. LPA interviewed the four other residents who did not report any concerns at the facility. LPA interviewed R1’s responsible party who did not provide information corroborating the allegation and stated that their only concern is that they had a disagreement with AD regarding the use of medications to treat R1’s mental health concerns.

CONTINUED

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20210824152139

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KATHRYN JANE RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 306001851
	VISIT DATE: 01/26/2026

NARRATIVE

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Regarding the allegation that facility staff do not treat resident with dignity: it was alleged that facility staff do not acknowledge R1’s thoughts and feelings and treated R1 like they are mentally ill, which has harmed R1’s emotional wellbeing. LPA interviewed AD who denied the allegation, stating R1 has emotional episodes during which R1 disturbs the atmosphere and makes accusations against staff and other residents, during these episodes AD spends time gently redirecting R1, and AD has worked with R1’s responsible party to address R1’s mental health concerns. Per AD, AD and R1’s responsible party have a disagreement on the use of medications to address R1’s mental health concerns. LPA interviewed S1 who was unable to provide information regarding the allegation, but stated that R1 and their family were happy with the facility, R1 stayed at the facility long after this issue was reported, and R1’s family referred a current resident to the facility. LPA interviewed one additional staff who did not corroborate the allegation. LPA interviewed R1 who confirmed they do not feel like they are treated well at the facility. LPA interviewed the four other residents who did not report any concerns at the facility. LPA interviewed R1’s responsible party who confirmed that they had a disagreement with AD regarding using medications to address R1’s mental health concerns, but did not provide information corroborating the allegation and did not allege that AD failed to follow R1’s doctor’s orders. The information obtained is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

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