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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006863
Report Date: 09/18/2026
Date Signed: 09/18/2026 12:58:06 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
09/14/2026 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260914101712
FACILITY NAME:SUMMERBREEZE COTTAGEFACILITY NUMBER:
306006863
ADMINISTRATOR:CARDENAS, LAWRENCEFACILITY TYPE:
740
ADDRESS:23961 STILLWATER LANETELEPHONE:
(562) 655-6545
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 6DATE:
09/18/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nathaniel CardenasTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Illegal Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to begin the investigation into the allegation listed above LPA met with Administrator Nathaniel Cardenas and explained the reason for the visit. LPA and the Administrator toured the facility.

The investigation into the allegation, illegal eviction, revealed the following. It was reported that Resident 1 (R1) is being evicted because their behavior has caused two staff members to quit. R1’s responsible party reported that the Administrator told them R1 is disruptive and is not a good fit for the facility, so they are being evicted. R1’s responsible party reported they were provided an eviction notice but they do not think the reason for eviction is valid. The Administrator reported that they served R1’s responsible party the eviction notice and R1’s behavior is disruptive and violates their house rules, so they are being evicted. LPA reviewed the eviction notice. No other supporting evidence such as special incident reports (SIRs), police reports or witness statements were provided in support of the information in the eviction notice.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
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-20260914101712
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: SUMMERBREEZE COTTAGE
FACILITY NUMBER: 306006863
VISIT DATE: 09/18/2026
NARRATIVE
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LPA reviewed the house rules which were provided to R1's responsible party at the time of admission. The eviction notice must comply with Title 22, 87224 Eviction procedures. The notice does not contain, The following exact statement as specified in Health and Safety Code Section 1569.683(a)(4): "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing." The statement is not in the eviction notice as required by Title 22, 87224(d)(1)(D). The eviction notice does not meet Title 22 requirements and is not valid. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore the allegation is substantiated. Deficiencies are being cited per Title 22, division 6 of the California Code of Regulations (CCR). An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260914101712
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: SUMMERBREEZE COTTAGE
FACILITY NUMBER: 306006863
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2026
Section Cited
CCR
87224(d)(1)(D)
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(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction... (1) The notice to quit shall include the following information: (D) The following exact statement as specified in Health and Safety Code Section 1569.683(a)(4)...
This requirement is not met as evidenced by:
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Administrator stated they will rescind the eviction and provide proof to the LPA by the POC due date. The Administrator states they will sign a statement of understanding stating that they have read and understand CCR 87224.
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Based on record review, Licensee did not comply with section cited above as 30-day eviction notice issued to R1 did not include statement as specified in Health and Safety Code Section 1569.683(a)(4), which poses a potential person 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: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
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