576804337-8-10-2026-21-AS-KMOA-DX4UTF-20260819155151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 576804337
Report Date: 08/07/2026
Date Signed: 08/10/2026 04:54:48 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2026 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20260428100750

FACILITY NAME:	CASCADE SENIOR CARE HOME LLC		FACILITY NUMBER:	576804337
ADMINISTRATOR:	DHILLON, SUKHJINDER K.		FACILITY TYPE:	740
ADDRESS:	2725 CASCADE ST.		TELEPHONE:	(916) 213-1942
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY:	6	CENSUS: 4	DATE:	08/07/2026
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Sukhjinder K. Dhillon, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff abandoned resident at the hospital.

Staff did not provide authorized representative with a copy of admissions agreement.

Staff did not provide authorized representative with a copy of resident’s care plan.

INVESTIGATION FINDINGS:

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***This is an amendment to report made on 8/7/2026.***
On 8/7/2026, Licensing Program Analyst (LPA) Nakagawa arrived at the facility unannounced to conduct a complaint investigation regarding the above allegations. LPA met with Administrator SUKHJINDER K. Dhillon to discuss findings.
The complaint alleges that Staff abandoned the resident (R1) at hospital. The complainant states that the facility Administrator informed the hospital case manager that R1 may not return until R1 is “more stable”. LPA reviewed text message correspondence between Administrator, DPOA and hospital. The Administrator informed the hospital that they will take the R1 back when stable. At the time of the response it was reported that R1 was highly confused and required a sitter in the hospital. Text messages to hospital from Administrator indicate that the facility was willing to take R1 back when stable and no longer requiring a sitter. Based on text messages to the hospital from Administrator the facility did not abandon the resident (R1) at the hospital. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.
(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260428100750

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CASCADE SENIOR CARE HOME LLC	FACILITY NUMBER: 576804337
	VISIT DATE: 08/07/2026

NARRATIVE

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(Continued from 9099)

The complaint alleges that Staff did not provide authorized representative with a copy of admissions agreement and Staff did not provide authorized representative with a copy of resident’s care plan. LPA reviewed copies of the admissions agreement and resident (R1)’s care plan and observed that both forms were completed and signed by the Administrator and R1’s responsible party on 3/24/2026 and 4/4/2026, respectively. The Administrator states that a copy of forms was provided to responsible party at the time of visit on 4/8/2026. Administrator states that they did not receive a request for a copy of the forms in person, by email or text from responsible party at any time. Based on review of completed documents and correspondence the allegation that a copy of the admissions agreement and resident’s care plan was not provided to R1’s authorized representative is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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