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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006496
Report Date: 01/21/2026
Date Signed: 01/21/2026 04:58:48 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
12/16/2025 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251216150102
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:Maria Perkins- CaregiverTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff did not communicate with resident’s family.
Facility staff did not follow resident’s dietary restrictions.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation into the above allegations. LPA was greeted by Caregiver Jesus Manalansan and stated the reason for the visit. During the course of investigation, LPA toured the physical plant, interviewed three witnesses, and five out of six residents. LPA was unable to obtain one resident's statement due to their medical condition. LPA obtained the following documentation for review: Resident Roster, Face Sheets, Physician's Reports, Admission Agreements, and menu.

The investigation revealed the following: Regarding the allegation, Facilty staff did not communicate with resident's family, it is alleged that the families were not informed about the new owner of the business. Per interviews, four witnesses and two residents who are self-responsible confirmed the change in administrator from Staff #1 (S1) to Staff #2 (S2). The interviewed parties mentioned that the change in administrator was communicated individually either in person, by phone call, or via text.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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 6
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
12/16/2025 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251216150102

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:Maria Perkins- CaregiverTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Licensee has lost control of property.
Licensee has sold the facility without proper notice.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation into the above allegations. LPA was greeted and granted entry by Caregiver Jesus Manalansan and stated the reason for the visit. During the course of investigation, LPA toured the physical plant, interviewed three witnesses, and five out of six residents. LPA was unable to obtain one resident's statement due to their medical condition. LPA obtained the following documentation for review: Resident Roster, Face Sheets, Physician's Reports, Admission Agreements, and legal documents/contracts.

The investigation revealed the following based on the three visits conducted on December 17, 2025, January 7, 2026, and Janaury 21, 2026: It is alleged that the licensee has lost control of property. During the intial visit, LPA observed six residents in care and two staff on duty. LPA observed all utilities (electricity, water, gas, trash collection, internet, and phone) are/were in working condition during the visits.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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: 2 of 6
Control Number 22-AS-20251216150102
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
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Based on the interviews, four out of six residents, three witnesses, and three staff confirmed all utilities remain working and the licensee remains in control of the property. In review of the Department's Notice of Application Submission Status dated January 29, 2024, the licensee is the legal title holder of the property per the notarized grant deed dated October 23, 2025. The licensee sold the business to Staff #2 (S2) per the business purchase agreement on August 29, 2025. The term of the lease agreement dated September 1, 2025 between licensee and S2 began September 1st ending August 31, 2031. LPA received an email from S2 on January 20, 2026 reporting their resignation as business owner and administrator, withdrawing the application from the Centralized Applications Bureau (CAB), and endorsing Staff #3 (S3) as of the same day. Per review of the subsequent notarized business purchase agreement dated January 18, 2026, S3 entered into agreement purchasing the business from the licensee and S2 as of January 16, 2026. The term of the lease agreement dated January 15, 2026 between licensee and S3 begins February 1, 2026 ending February 1, 2031. As of today's date, S3 confirmed not submitting the application to CAB.

Regarding the allegation, It is alleged that the Licensee has sold the facility without proper notice, it is alleged that the responsible parties were not given notice of the sale of the facility (or business). Based on the interviews, four witnesses and the two residents who are self-responsible, were informed about the change in management from Staff #1 (S1) to Staff #2 (S2) either in person, by phone call, or via text. Although, the residents and or their representatives were informed about the sale of the business, the licensee failed to issue proper written notices to the Department at least 30 days prior to the transfer.

The investigation reveals that "control of property" is a requirement imposed on the licensee and applied continuously, meaning a licensee must maintain "control" for the duration of the license, and the Department may require evidence of control of the licensed property. In the case of losing control of property, the licensee lost control when the business was sold to S2 and subsequently S3. Additionally, the Department and residents and/or their representatives were not informed in writing at least sixty (60) days prior the transfer of business, or at the time that bona fide offer is made, whichever period is longer for both business transactions to S2 and S3.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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 6
Control Number 22-AS-20251216150102
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
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Therefore, based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegations: Licensee has lost control of property and Licensee has sold the facility without proper notice are deemed SUBSTANTIATED. Deficiencies are being cited on the attached LIC9099-D.

An exit interview was conducted with Caregiver Maria Perkins in person and Administrator Jeannie Dao via telephone, and a copy of this report including the appeal rights and Confidential Names (LIC811) were provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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: 4 of 6
Control Number 22-AS-20251216150102
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2026
Section Cited
CCR
87112(a)
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 87112 Conditions for Forfeiture of a License (a) Conditions for forfeiture of a residential care facility for the elderly license shall be as specified in Health and Safety Code section 1569.19. This requirement was not met as evidenced by:
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Administrator Dao stated that the application to apply for a license will be submitted to CAB and will provide proof to LPA by POC due date.
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Based on interviews and the records reviewed, the licensee lost control of property when the business was transferred twice to S2 and subsequently S3 which poses a potential Health, Safety, and or Personal Rights risk to persons in care.
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Type B
01/30/2026
Section Cited
CCR
87109(b)
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87109 Transferability of License (b) The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer... This requirement was not met as evidenced by:
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Administrator Dao will submit a letter to the Department, residents, and/or their representatives immediatelly reporting the change in management and ownership of the business as well as an Acknowledgement of Understanding of the said regulation to LPA by POC due date.
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Based on interviews and the records reviewed, the Department and residents and/or their representatives were not notified of the transfer of the business within the required time above which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

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

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20251216150102
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
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LPA reviewed the text messages sent to the responsible party who is the conservator of Resident #1 (R1) per the conservatorship document dated April 24, 2024. LPA confirmed that conservator of R1 was notified of the change of administrator via text message.

Regarding the allegation, Facility staff did not follow resident's dietary restrictions, it is alleged that the facility fed R1 eggs and bacon causing R1 to be admitted to the hospital from a reaction. The complainant denied the allegation indicating R1 not having a special diet and food allergies which includes eggs and bacon. In review of the Physician's Report (LIC602), it is confirmed that R1 does not have a special diet prescribed by the doctor. Five out of six residents and three out of three witnesses reports residents receiving three meals a day with snacks in between and expressed no concerns.

Therefore, this agency has investigated the complaint and based on the observations made, interviews which were conducted, and the records that were reviewed, the following allegations: Facility staff did not communicate with resident's family and Facility staff did not follow resident's dietary restrictions are deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Caregiver Maria Perkins in person and Administrator Jeannie Dao via telephone, and a copy of this report including the Confidential Names (LIC811) were provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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: 6 of 6