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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006062
Report Date: 07/02/2026
Date Signed: 07/02/2026 04:08:44 PM

Substantiated


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
07/02/2026 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260702082618
FACILITY NAME:JADE GUEST HOMEFACILITY NUMBER:
306006062
ADMINISTRATOR:DAO, BREVETFACILITY TYPE:
740
ADDRESS:2710 N. BERKELEY STTELEPHONE:
(714) 333-5363
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:6CENSUS: 5DATE:
07/02/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jean VeracruzTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff yell at resident
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Jean Veracruz, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that staff yell at resident revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, staff, and residents, and obtained and reviewed copies of the resident roster and staff roster.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
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
Control Number 22-AS-20260702082618
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: JADE GUEST HOME
FACILITY NUMBER: 306006062
VISIT DATE: 07/02/2026
NARRATIVE
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It was alleged that staff yell at Resident #1 (R1), harass R1, and speak badly about R1. LPA interviewed AD and one staff who denied the allegation. LPA interviewed the three other residents present, and the two residents who could communicate did not provide any information corroborating the allegation. During the inspection, LPA observed a verbal confrontation between R1 and AD, but while R1 yelled loudly at AD and other staff and slammed the table, the staff did not yell back at R1. However, during a previous phone call with R1, LPA overheard a staff say something loudly towards R1 in an argumentative manner, but was unable to identify the staff.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20260702082618
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: JADE GUEST HOME
FACILITY NUMBER: 306006062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2026
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) … (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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Licensee stated that they will retrain staff on deescalating tense situations and speaking to residents with dignity.
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Based on observation, the licensee did not ensure R1 was treated with dignity when staff spoke loudly towards R1 in an argumentative manner, which poses a potential 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.
SUPERVISOR'S NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 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
07/02/2026 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260702082618

FACILITY NAME:JADE GUEST HOMEFACILITY NUMBER:
306006062
ADMINISTRATOR:DAO, BREVETFACILITY TYPE:
740
ADDRESS:2710 N. BERKELEY STTELEPHONE:
(714) 333-5363
CITY:ORANGESTATE:CAZIP CODE:
92865
CAPACITY:6CENSUS: 5DATE:
07/02/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jean VeracruzTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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2
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9
Staff handled resident in an aggressive manner
Staff do not safeguard resident’s personal belongings
Staff mishandle resident's P&I funds
Facility staff are not providing telephone access to residents
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Administrator (AD) Jean Veracruz, discussed the purpose of the inspection, and explained the allegations.

The investigation into the allegations that staff handled resident in an aggressive manner, staff do not safeguard resident’s personal belongings, staff mishandle resident's P&I funds, and facility staff are not providing telephone access to residents revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, staff, and residents, and obtained and reviewed copies of the resident roster and staff roster.

CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20260702082618
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: JADE GUEST HOME
FACILITY NUMBER: 306006062
VISIT DATE: 07/02/2026
NARRATIVE
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Regarding the allegation that staff handled resident in an aggressive manner: it was alleged that staff push and hit Resident #1 (R1). LPA interviewed R1 who stated AD pushed them last year resulting in their hospitalization with a pelvis injury. LPA interviewed AD and one staff who denied the allegation, stating R1 fell outside the facility while intoxicated last year as they are free to leave the facility, but they are unsure of the injury. LPA interviewed the three other residents present, and the two residents who could communicate did not provide any information corroborating the allegation. The information obtained is conflicting.

Regarding the allegation that staff do not safeguard resident’s personal belongings: it was alleged that staff stole R1’s food stamp card and food. When interviewed, R1 stated they had given AD the food stamp card for AD to buy items for R1 and also allowed AD to use it for themselves, AD had overspent, R1 demanded the card back and AD had returned it, and other staff had stolen some of R1’s eggs. LPA interviewed AD and one staff who denied the allegation. Per one staff, R1’s allegation regarding the eggs is a misunderstanding, no eggs were actually missing or stolen from R1, and staff gave R1 the allegedly missing eggs from their own supplies when the issue was raised. Per AD, R1 gave AD their food stamp card to buy groceries for R1, AD followed R1’s shopping list, although R1 offered to allow AD to purchase things for themselves using the card AD never did, and R1 did not have enough money to purchase everything they needed at one point so AD used their own money to purchase R1’s groceries for them. LPA interviewed the three other residents present, and the two residents who could communicate did not provide any information corroborating the allegation.

Regarding the allegation that staff mishandle resident's P&I funds: it was alleged that AD uses R1’s P&I money to purchase personal items for themselves. When interviewed, R1 stated AD used their food stamp money for their own use. LPA interviewed AD who denied the allegation, stating R1 gave AD their food stamp card to buy groceries for R1, AD followed R1’s shopping list, although R1 offered to allow AD to purchase things for themselves using the card AD never did, and R1 did not have enough money to purchase everything they needed at one point so AD used their own money to purchase R1’s groceries for them. LPA interviewed the three other residents present, and the two residents who could communicate did not provide any information corroborating the allegation.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20260702082618
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: JADE GUEST HOME
FACILITY NUMBER: 306006062
VISIT DATE: 07/02/2026
NARRATIVE
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Regarding the allegation that facility staff are not providing telephone access to residents: it was alleged that staff are not allowing R1 to use the facility telephone. LPA interviewed R1 who stated their phone was not working so they used the facility phone for internet access, staff needed to use it so they demanded it back and accused R1 of stealing the phone, and R1 has since avoided using the facility phone due to this pushback. LPA interviewed AD and one staff who denied the allegation, stating that the facility has a cell phone that also has internet access, that R1 used it for an entire day despite having their own phone, but that staff also need to use it to coordinate resident care. Per AD and one staff, R1 is able to use the phone and its internet access reasonably and they have not prevented R1 from using the phone. LPA interviewed the three other residents present, and the two residents who could communicate did not provide any information corroborating the allegation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6