Summerbreeze Cottage

Allegation investigated: Illegal Eviction

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 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.the state’s words, verbatim · CDSS document, Sep 18, 2026 · control 22-AS-20260914101712

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1)(D) · Plan of correction due date: Sep 25, 2026

(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: 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 carethe state’s words, verbatim · CDSS document, Sep 18, 2026

Plan of correction: 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.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the second pre-licensing visit. LPA met with applicants Lawrence Cardenas and Nathaniel Cardenas. See LIC 809 dated April 27, 2026 for more information. LPA observed and verified the following items have been corrected. All items including, the lawn mower, garden equipment, construction supplies, ladder, wheel barrow and glass panels have been removed from the side of the house. The side yard with the exit gate is clear of obstacles and hazards. The 3 beds with bed rails have been removed and replaced with 3 beds with no rails. The exit gate in the backyard on the back fence has been closed and is now a solid wall. The exit gate leading to the driveway has an exit alarm that is operational that sounds when the gate is opened. Facility has an internet device dedicated for resident use. The facility is ready to be licensed. LPA informed the applicant that final approval for licensure will be approved by CAB (Central Applications Bureau) in Sacramento. Applicants stated they understood. LPA consulted with applicants concerning reporting requirements. Exit interview was conducted and a copy of this report was provided to the applicants.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the pre-licensing inspection. LPA met with applicants Lawrence Cardenas and Nathaniel Cardenas. An initial application to operate a Residential Care Facility for the Elderly (RCFE) for 6 non-ambulatory residents of which 1 can be bedridden (bedroom #2) was submitted to Community Care Licensing (CCL) on October 20, 2025. Facility requested a hospice waiver for 6. Facility phone number 949-503-1505. Structure. The facility is a one story house with 6 bedrooms, 3 bathrooms, living room/dining room, kitchen and an attached 2 car garage. The garage is kept locked and used for storage. LPA observed the fire extinguishers in the kitchen, main entry way and the garage are fully charged. LPA observed the See Something, Say Something sign (PUB 475) posted in the main entryway. Resident rooms. LPA observed all the resident rooms have the required furnishings and bed linens. LPA observed there is a TV in the living room and 6 recliners. LPA observed extra linens stored in the hall pantry. Bathrooms. Facility has 3 bathrooms and all bathrooms are clean and operational. Water Temperature. LPA measured the hot water at 117.2 degrees Fahrenheit in all 3 bathrooms. Emergency Phone Numbers & Exit Plan. LPA observed the following postings, Personal Rights of Residents, Facility's Theft and Loss Policy, Rights of Resident Councils and the Emergency Disaster plan. The facility sketch showing all emergency exits and exit routes is posted throughout the facility. Appliances. LPA observed the 5 burner stove, oven, microwave oven and refrigerator and dishwasher are all clean and operational. The 5 burner gas stove lights unassisted. The washer and dryer in the garage are clean and operational. Extra cleaning supplies are kept locked under the kitchen sink. Food Service. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The garage is kept locked and used for storage. LPA observed a 3 day emergency supply of food and water in the garage. Toxins and cleaning supplies are kept locked under the kitchen sink. Resident & Staff Files will be kept secured in the hall closet. Medications are kept locked in the medication cabinet in the kitchen. First-Aid Kit & Book are kept locked in the closet. LPA observed the first aid kit has all the required elements except the First Aid Manual. Reading Material, Games, Equipment & Materials. LPA observed board games living room. Fire clearance, the fire clearance was approved by Orange County Fire Authority on February 26, 2026. Backyard No bodies of water observed. LPA observed a table with an umbrella and 6 chairs for residents to sit outside. The exit gate is operational and self closing. LPA observed garden equipment, construction supplies, ladder, wheel barrow and glass panels on the side of the house. The back fence has an exit leading to hill slope. The exit gate is an aluminum and is not permanently attached to the fence. The exit gate is a safety hazard. Smoke Detectors/Carbon monoxide detectors tested operational. Component III: Completed. Facility does not have an internet device (Tablet) dedicated for resident use only. LPA observed all exit doors including exit doors in resident rooms have door alarms that are operational. The exit gate in the backyard does not have an exit alarm. The facility is not ready to be licensed. Applicant stated they would contact the LPA to schedule the next visit. The following items must be corrected prior to the facility being licensed. All items including, the lawn mower, garden equipment, construction supplies, ladder, wheel barrow and glass panels must be removed from the side of the house. The 3 beds with bed rails must have the rails removed. The exit gate in the backyard on the back fence must be replaced or permanently closed. The exit gate leading to the driveway must have an exit alarm installed. LPA informed the applicant that final approval for licensure will be approved by CAB (Central Applications Bureau) in Sacramento. Applicants stated they understood. Exit interview was conducted and a copy of this report was provided to the applicants.the state’s words, verbatim · CDSS document, Apr 27, 2026

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): Method: Telephone call with CAB COMP II Participants: Cardenas, Lawrence; Cardenas, Sarah On 3/6/2026, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 6, 2026