<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006496
Report Date: 01/21/2026
Date Signed: 01/21/2026 05:50:34 PM

Unfounded


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
12/22/2025 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20251222133927
FACILITY NAME:HOME AT CASCADE LANE, INC.FACILITY NUMBER:
306006496
ADMINISTRATOR:AVILA, MARIA JASMINFACILITY TYPE:
740
ADDRESS:15311 CASCADE LANETELEPHONE:
(714) 515-0459
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jeannie Dao - Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of care and supervision
Facility staff are not dispensing medications as prescribed
Facility are not providing residents privacy
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 21, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for a subsequent complaint investigation visit into the above allegations. LPA was greeted and granted entry after stating the purpose of the visit to staff. Administrator Jeannie Dao was contacted via telephone, notified about the reason for the visit, and granted permission for Caregiver Maria Perkins to sign the report.

Regarding allegation, Lack of care and supervision, it is alleged that Resident 1 (R1) is sleeping in a recliner chair in the living room, resulting in falls and sustaining bruising. During visits conducted on December 29, 2025 and January 7, 2026, LPA observed R1 watching television and falling asleep on the recliner in the living room, after breakfast and lunch. On multipe ocassions throughout the visits, LPA observed staff in the living room, checking on R1 and attending to all residnets in care. Four out of four residents interviewed denied there being a lack of supervision at the facility as staff respond to their calls promptly and check on each person regularly.
CONTINUE TO LIC9099-C....
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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-20251222133927
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: HOME AT CASCADE LANE, INC.
FACILITY NUMBER: 306006496
VISIT DATE: 01/21/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During an interview with R1, R1 stated they prefer to sleep in the recliner instead of the bed because it is more comfortable, they enjoy watching television, and also like to joke with staff and visitors while in the living room. R1 stated they have no pain and have not experienced any falls or bruises by sleeping in the chair. Four out of four witnesses denied the allegations stating stating R1 sometimes falls asleep while watching TV in the living room and has not sustained any falls or bruising as a result and also it is R1’s preference to sleep in the recliner. Three out of three staff denied the allegation, stating residents are responded to quickly and checked on regularly. Records were reviewed for R1, and LPA did not find any documentation noting R1 sustained falls or bruising due to sleeping in the recliner.

Regarding the allegation, Facility staff are not dispensing medications as prescribed, it is alleged that facility staff are not administering eight medications prescribed for R1 and R1 is not being provided with the nasal spray. During the visit on January 7, 2026, LPA observed S1 dispensing medications and placing it in individual cups assigned to the residents which had their names. R1 stated during the interview confirming that the medications are administered during meal times, emptied into their hand, and then taking by mouth. Four out of four residents and three out of three staff interviewed stated that medications are administered timely. A record review of R1’s Physician’s Order Sheet dated December 29, 2025, documents R1 is prescribed twelve (12) routine and two (2) Pro Re Nata (PRN) medications. Based on the review of the Medication Administration Records (MARs), all medications were given appropriately and timely.

Regarding allegation, Facility are not providing residents privacy, it is alleged that staff are not providing residents’ privacy during visitation and visits are being video recorded without consent. Based on the inspections, cameras were not present in the residents’ rooms. A working, disabled surveillance camera was observed in the kitchen area during previous visits, however was observed not in use and removed on January 7, 2026. Four out of four residents, which includes R1, denied the allegation stating that visits are uninterrupted and privacy is given. R1 stated staff have not video recorded any private visits and stated their family member utilized their phone to video record the staff instead. Three out of three staff denied recording residents and visitors in their bedrooms.

CONTINUE TO LIC9099-C....
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251222133927
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: HOME AT CASCADE LANE, INC.
FACILITY NUMBER: 306006496
VISIT DATE: 01/21/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
This agency has investigated the complaint, and based on observations made, interviews conducted, and records reviewed, the allegations, Lack of care and supervision and Facility are not providing residents privacy, are deemed UNFOUNDED. We have found that the above allegations are unfounded, meaning that the allegations are false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Jeannie Dao and was granted permission for Caregiver Maria Perkins to sign the report. A copy of this report was provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3