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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006062
Report Date: 12/30/2025
Date Signed: 02/05/2026 10:50:22 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
01/21/2025 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250121083618
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: 4DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Administrator Lady Jean VeracruzTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee modified the admission agreement without department approval.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jenifer Tirre made a subsequential visit to deliver findings on complaint investigation. LPA Tirre was greeted and granted entry into the facility by caregiver and explained reason for visit. Administrator Lady Jean Veracruz was present during visit.
During the course of investigation, the Department conducted interviews and reviewed documents. The investigation conducted revealed the following:
Department conducted a record review of residents Admission’s agreements. LPA reviewed Four Resident agreements and LPA observed on two Residents Agreements (residents 3 and 4) have handwritten on pages 10 and 11, “No refund when on hospice care".
On R4’s agreement a Responsible party signature is provided on bottom. On R3’s Agreement no responsible parties signature is provided due to R3 being own responsible party. LPA did not observe handwritten “no refund” on Residents 1 and 2’s agreement. Record review revealed that all four residents were under Hospice Care.
CONTINUED ON 9099C
***THIS IS AN AMENDED REPORT***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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-20250121083618
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: 12/30/2025
NARRATIVE
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Interviews conducted revealed one of four residents who is under Hospice care, stated they signed their Admission agreement and Licensee reviewed agreement with them. Resident stated they can not recall refund policy. Three of four residents were unable to provide information regarding Agreements.

As a result of information gathered in complaint investigation, the allegation Licensee modified the admission agreement without department approval is deemed as SUBSTANTIATED, meaning that the preponderance of evidence has been met.

Based on record review, a deficiency is being cited as per the Title 22 Division 6 Chapter 8 of the California Code of Regulations.



An exit interview was conducted with Administrator Lady Jean Veracruz and a copy of this report along with appeal rights was provided to facility representative..

***THIS IS AN AMENDED REPORT***

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2