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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006496
Report Date: 07/15/2026
Date Signed: 07/15/2026 04:36:53 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
04/20/2026 and conducted by Evaluator Eboni Bentley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260420170844
FACILITY NAME:HOME AT CASCADE LANE, INC.FACILITY NUMBER:
306006496
ADMINISTRATOR:JEANNIE DAOFACILITY TYPE:
740
ADDRESS:15311 CASCADE LANETELEPHONE:
(714) 515-0459
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
07/15/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jeannie Dao - AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Facility is not allowing visitors
Facility phone is non operational
Facility does not retain resident records
Facility is not allowing resident to attend church
Facility staff took residents property
INVESTIGATION FINDINGS:
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On July 15, 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 and arrived shortly to assist with the visit.

During the course of the investigation, LPA reviewed facility documents including: Resident Roster, Staff Roster, Physician’s Reports, and Needs and Service Plans. Interviews were conducted with residents and staff.
Regarding the allegation, Facility is not allowing visitors, it is alleged that the facility is not permitting visitation for residents. Five out of six residents interviewed denied the allegation. Resident 5 (R5) and Resident 6 (R6) stated their visitors have never been turned away and they always adhere to the visiting hours. LPA observed Visiting Hours of 9am-7pm Daily, posted in the entry way.
REPORT CONTINUES ON LIC9099-C….
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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-20260420170844
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: 07/15/2026
NARRATIVE
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Three out of three staff denied the allegation, stating residents are always allowed to have visitors during visiting hours. Per Administrator, there are no restrictions on visitations unless they are before or after visiting hours. There is no evidence to support the allegation that staff are not allowing visitors.

Regarding the allegation, Facility phone is non operational, it is alleged that facility telephone is not in working order. Based on observation, LPA observed a working telephone in the kitchen area. LPA Bentley tested the facility phone at (714) 373-1218 and it was deemed operational. Three out of three staff denied the allegation stating the facility phone is available to residents in care. Six out of six residents denied the allegation stating they are permitted to use the facility phone for incoming and outgoing calls when needed. Two out of six residents have their own cell phone.

Regarding the allegation, Facility does not retain resident records, it is alleged that the facility is not retaining resident records. Three out of three staff interviewed denied the allegation. During the investigation, LPA observed resident records securely stored in the closet with medication. A record review revealed the facility retained records for all six residents in care, including Physician’s reports, Doctor’s orders, Needs and Service Plans, Consent forms, Medication records, and Admission Agreements.

Regarding the allegation, Facility is not allowing resident to attend church, it is alleged that the facility is restricting R1 from attending church services. Three out of three staff interviewed denied the allegation, stating the resident have not made any requests to attend church. During the interview, R1 stated they are not interested in attending church services and staff has not restricted them from attending.

Regarding the allegation, Facility staff took residents property, it is alleged that facility staff removed an APS business card from R1’s room. Three out of three staff interviewed denied the allegation, stating they did not remove the business card and was not aware that R1 had it in their possession. There is no evidence to support the allegation that staff removed the APS business card from R1’s bedroom.

Based on the observations made, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the aforementioned allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Jeannie Dao and a copy of this report was provided at the end of the visit.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2