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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005722
Report Date: 02/18/2026
Date Signed: 02/18/2026 11:09:38 AM

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
01/27/2026 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260127120316
FACILITY NAME:IRIS GUEST HOMEFACILITY NUMBER:
306005722
ADMINISTRATOR:DAO, BREVETFACILITY TYPE:
740
ADDRESS:2702 N BERKELY STTELEPHONE:
(714) 310-4436
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:6CENSUS: 5DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
07:13 AM
MET WITH:Administrator Lady Jean VeracruzTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff did not ensure resident's records were complete
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced subsequent visit to follow up on complaint investigation. LPA Tirre was greeted and granted entry into the facility by staff and explained reason for visit. LPA Tirre met with Administrator Lady Jean Veracruz.

During the course of investigation, LPA toured facility, reviewed documents, conducted interviews and requested pertinent documentation such as Resident 1’s records including Admission Agreement, Physician’s Report, Appraisal, Needs and Service plan. The investigation conducted revealed the following:
On January 27, 2026 the department received a complaint alleging Facility staff did not ensure resident's records were complete.
Record review revealed that R1 had the following documents: Emergency ID Information, Preplacement Appraisal, and Resident Appraisal were all incomplete and not signed. Per record review

CONTINUED ON 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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-20260127120316
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: IRIS GUEST HOME
FACILITY NUMBER: 306005722
VISIT DATE: 02/18/2026
NARRATIVE
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 LPA did not observe Resident 1 to have an Admission Agreement completed or signed in facility file. Record review revealed that resident 1 was admitted to facility on December 10, 2025 and left on January 6, 2026.

Interviews conducted with staff revealed that Resident 1 was at facility for a month and left to go back home to be with family. Interview with witness also revealed that R1 was at facility for a month. Interview with witness stated that R1 believes they signed documents but were not explained of what they signed. An interview with R1 was not conducted due to R1 no longer at facility and no contact info available.

Therefore based on preponderance of evidence information gathered is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred.



The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.


An exit interview was conducted with Administrator Lady Jean Vera Cruz and a copy of this report, along with confidential names list and appeal rights was reviewed and provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260127120316
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: IRIS GUEST HOME
FACILITY NUMBER: 306005722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2026
Section Cited
CCR
87506(a)
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Resident Records (a) Licensee shall ensure that a separate, complete, and current record is maintained for ea resident in facility or in central administrative location readily available to facility staff and licensing agency staff. Based on record review this requirement was not met as evidenced by
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As POC, Licensee to review and update Resident files with missing signatures. Licensee to do an inservice training including themselves and staff acknowledging understanding of Regulation 87506 Resident Records & provide signed copy to Department by COB due date 2/25/26
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facility failed to ensure resident records were complete. R1 is missing signatures on appraisals and missing Admission agreement.R1 is no longer at facility as of 1/6/26.This poses a potential health & safety risk to residents 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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3