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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006062
Report Date: 08/12/2026
Date Signed: 08/28/2026 02:19:47 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
08/11/2026 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20260811151254
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: 0DATE:
08/12/2026
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH: Jean VeracruzTIME COMPLETED:
11:11 AM
ALLEGATION(S):
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Unlawful eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sam Haddadin conducted an unannounced complaint investigation visit on 08/12/2026 regarding the allegation listed above. LPA met with Administrator (AD) Jean Veracruz and explained the purpose of the visit.
During the investigation, LPA conducted interviews, reviewed facility records, and conducted a health and safety walk. LPA interviewed two staff members. Two out of two staff corroborated the allegation.
After trying several times to get hold the licensee , LPA was able to interview the Licensee via telephone. The Licensee stated that all residents residing at Jade Guest Home had been moved to Iris Guest Home because Jade Guest Home did not have enough staff to continue providing care at the facility. During the health and safety walk, LPA confirmed that the residents from Jade Guest Home had been relocated to Iris Guest Home.
{***THIS IS AN AMENDED REPORT***}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
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 3
Control Number 22-AS-20260811151254
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: 08/12/2026
NARRATIVE
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The 30-day eviction notice was provided to LPA on the day of the visit. LPA reviewed the 30-day eviction notice issued to Resident 1 (R1), dated 07/12/2026, which stated that R1’s lease agreement would terminate on 08/10/2026. LPA was unable to confirm whether R1 had been provided with the 30-day eviction notice. R1 was hospitalized and was not allowed back to the facility .
Pursuant to Health and Safety Code section 1569.683(a)(4), if a resident remains in the facility after the effective date of an eviction notice, the licensee must file an unlawful detainer action in Superior Court and obtain a written judgment authorizing the eviction. During an interview with the licensee, the licensee stated that an unlawful detainer action had not been filed with the Orange County Superior Court.
The investigation determined that the facility refused to allow R1 to return to Jade Guest Home; therefore, R1 was unlawfully evicted. The investigation further established that Jade Guest Home was no longer maintaining residents at the facility due to insufficient staffing and that all residents had been relocated to Iris Guest Home. The Licensee's statement, LPA's observations during the health and safety walk, and statements obtained from two out of two staff members corroborated the allegation.
Based on interviews conducted, records reviewed, and observations made during the investigation, the preponderance of evidence standard has been met; therefore, the allegation is SUBSTANTIATED.
An exit interview was conducted, and a copy of this report, along with appeal rights, was provided.
{***THIS IS AN AMENDED REPORT***}
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260811151254
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: 08/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2026
Section Cited
CCR
87224(a)
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{****THIS IS AN AMENDED DEFICIENY****}
87224(a)"The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1). A Thirty (30) days written notice to the resident is required" This requirement was
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By the POC due date, the licensee shall review Section 87224 and Health and Safety Code section 1569.683 and provide staff training on proper eviction procedures. Verification shall include a signed training roster and a written
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not met as evidenced by: Based on interviews and record review, R1 was hospitalized and was not allowed to return which posed an immediate personal rights risk to residents in care.
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statement from the licensee confirming compliance with applicable eviction requirements. Documentation shall be submitted to CCL by the POC due date.
CCR
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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: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
LIC9099 (FAS) - (06/04)
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