Jade Guest Home

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 CareRead the full finding— CDSS inspection report, December 30, 2025 · control 22-AS-20250121083618

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to deliver findings for complaint investigation into the above allegations. LPA explained the reason for the visit with Administrator Lady Jean Vera Cruz. During the course of the investigation LPA toured facility, reviewed records, conducted staff interviews, made visual observations, documented photos of belongings and requested pertinent documentation such as Admission agreement, resident personal property and valuables and emergency identification form. During investigation LPA reviewed facility records such as resident admission agreement dated March 17, 2024, which noted under “Belongings Removal” section, “In the event of resident vacating premises, facility will make reasonable efforts to assist resident or responsible person with belongings removal. Facility requires all resident personal belongings to be removed as quickly as responsible party can”. LPA also reviewed Resident’s Personal prRead the full finding— CDSS inspection report, September 16, 2025 · control 22-AS-20250914154018

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the two allegations listed above as well as to deliver findings to the licensee. LPA was greeted and granted entry by facility caregivers after introducing himself and stating the purpose of the visit. Administrator Jean Veracruz was notified of the visit and assisted. An initial investigation visit was conducted by licensing staff on January 6, 2025. LPAs accompanied by facility staff toured the facility's physical plant. There were four residents in care, all of which are receiving hospice care. LPAs requested and reviewed resident records for all four residents as well as for a recently deceased resident. Two staff interviews and one resident interview conducted during the visit. During the present visit, LPA conducted an additional tour of the premises and two staff interviews. Additional witness interviews conducted viaRead the full finding— CDSS inspection report, March 21, 2025 · control 22-AS-20241230110812

(This is an amended report.) This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by Leonor Gamolo, Caregiver. LPA met with Administrator Brevet Dao via phone call and explained the nature of the inspection to her and staff. The department received a complaint on 8/14/2024 alleging Licensee is not ensuring that a separate, complete, and current record is maintained for resident in care and Staff do not respond to requests for communication regarding resident in care in a timely manner. During the investigation, the department interviewed facility Administrator (AD) and staff. On 8/23/2024 LPA conducted a visit to the facility to initiate investigation into the above allegations. LPA obtained copies of the personnel report and resident census. LPA also obtained electronic copies of all records theRead the full finding— CDSS inspection report, September 10, 2024 · control 22-AS-20240814101419

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Administrator/Licensee Brevet Dao and explained the reason for the visit. The Department received the complaint on 08/07/2023 and LPA Quiroz conducted the initial 10-day visit on 08/15/2023 and LPA Mendivil conducted a follow up visit on 03/27/2024. LPA Mendivil interviewed staff and was unable to interview residents as all were asleep at the time of the visit. LPA Mendivil obtained copies of documents such as admission agreement and physician’s report. Regarding the allegation Facility staff failed to provide adequate care and supervision, resulting in injury, the investigation revealed the following: Per review of Resident’s 1 (R1) documentation R1 arrived at the facility on 07/26/2023. Based on R1’s physician report dated 07/2023 it was noted that R1 is diagnosed with hypertensive heart disease with heart failureRead the full finding— CDSS inspection report, April 15, 2024 · control 22-AS-20230807135753

On this day Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Melanie Geller, Caregiver and explained the reason for the visit. Administrator Brevet Dao arrived at the facility shortly after. The Department received the complaint on 01/16/2024 and LPA Mendivil conducted the initial 10 day visit on 01/22/2024. LPA Mendivil interviewed staff and obtained copies of pertinent documents including: physician's reports, admission agreement and medication administration record. LPA Mendivil was unable to interivew residents as they were asleep during visits. Regarding the allegations staff did not seek medical attention for resident's change in condition, staff did not reposition bedridden resident, staff did not treat resident with dignity, staff did not administer resident's medication as prescribed, staff are unable to meet residents needs due to language barrier and staff leftRead the full finding— CDSS inspection report, March 5, 2024 · control 22-AS-20240116131630

On today's day Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced complaint visit to address the allegation listed above. LPA Quiroz was greeted and granted entry into the facility by Caregiver Teresa Del Pilar and explained the reason for the visit. Caregiver DePilar called Administrator (AD) Brevet Dao. LPA Quiroz discussed purpose of today's visit with AD Dao via telephone. Regarding the allegation: "Facility staff did not ensure that wheelchair bound resident has safe access to the restroom," the investigation revealed the following: During today's visit, LPA Quiroz observed and inspected two of two bathrooms in the facility. During today's visit, Caregiver Teresa Del Pilar demonstrated how a large size wheel chair is able to fit in and out of bathroom near facility entrance. Interviews conducted with five of five interviewees revealed that they are aware that front bathroom near facility entrance accomodates easily wheelchair access availability. CONTINUED ON NEXT PARead the full finding— CDSS inspection report, May 16, 2023 · control 22-AS-20230509084157

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit in order to deliver complaint findings. LPA was greeted and granted entry into the facility by Teresa De Pilar and explained the reason for the visit. The Department received a complaint on 10/26/2022 and conducted the initial visit on 10/31/2022. LPA Mendivil obtained copies of pertinent documents including but not limited to: staffing documents, medication records and facility roster. In regards to the allegations facility staff lack emergency disaster training, facility does not have emergency oxygen, and An uncleared individual is living in facility, the investigation revealed the following: UnfoundedRead the full finding— CDSS inspection report, April 25, 2023 · control 22-AS-20221026135817

Licensing Program Analyst Michelle Reed arrived at the facility to discuss the complaint allegations. Upon arrival, LPA met with Ben Briones Mr. Briones informed LPA that R1 did not reside at this facility. He resided at 2702 Berkeley St. which is the sister facility in front named Iris Guest Home. The homes share the same property and structure but have two different addresses. Based upon interview with Mr. Briones these allegations are unfounded at this facility, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. R1 never lived at this facility. An exit interview was conducted and a copy of this report was given to Ben Briones. Allegations will be investigated at Iris Guest Home #306005722. UnfoundedRead the full finding— CDSS inspection report, January 27, 2023 · control 22-AS-20230117133658

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced complaint visit. LPA was greeted and granted entry into the facility by Caregiver Teresa Del Pilar and explained the reason for the visit. The department received a complaint on 01/17/2023. LPA Mendivil visited facility on 01/18/2023 . Regarding the allegation the facility has no heat,the investigation revealed the following: LPA Mendivil observed the thermostat at 77 degrees fahrenheit on 01/18/2023 during the initial 10 day visit. During the complaint delivering visit the thermostat read at 78 degrees fahrenheit. Interviews with staff and residents indicate the heater is on daily. UnfoundedRead the full finding— CDSS inspection report, January 20, 2023 · control 22-AS-20230117164826