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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006496
Report Date: 01/28/2026
Date Signed: 01/28/2026 12:20:41 PM

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
01/21/2026 and conducted by Evaluator William Vanegas
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260121075045
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:
01/28/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator Jeannie DaoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff are ignoring call buttons.
INVESTIGATION FINDINGS:
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On today's date January 28, 2026 Licensing Program Analysts (LPA's) William Vanegas and Brandon Lopez made an unannounced visit to the facility to initiate the investigation to the above listed allegation and to deliver the complaint findings. LPA's were greeted and granted entry to the facility by facility staff, LPA's explained the purpose of the visit, LPA's conducted a tour of the facility and observed residents in care lounging in respective common areas and their bedrooms.

LPA's conducted resident and staff interviews. Additionally LPA's collected and conducted record review for residents in care, documents collected include; resident roster, staff records, and resident records.

Regarding the allegation that, facility staff are ignoring call buttons, the following has been concluded: LPA's conducted five resident interviews. Two out of the five residents were unable to be qualified for an interview. Another resident interviewed confirmed the allegation and stated that staff sometimes do not respond to their call button when they needs assistance. CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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 2
Control Number 22-AS-20260121075045
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: 01/28/2026
NARRATIVE
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However, two out of the five residents interviewed denied the allegation and stated that staff have always assisted them when they pressed their call button. LPA's conducted three staff interviews. Three out of the three staff interviewed denied the allegation and stated that staff immediately assist resident's when they press their call buttons. During the visit, LPA's tested the call buttons and observed them to be operational. LPA's also observed staff respond to the resident's when they pressed their call buttons.

Due to the conflicting information received during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Jeannie Dao and a copy of the report was provided.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2