<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005880
Report Date: 11/03/2025
Date Signed: 11/03/2025 11:55:32 AM

Unfounded


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
11/16/2021 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211116080904
FACILITY NAME:SHORELINE SENIOR LIVINGFACILITY NUMBER:
306005880
ADMINISTRATOR:EDGINGTON, HEATHERFACILITY TYPE:
740
ADDRESS:7101 NIMROD DRTELEPHONE:
(714) 916-0029
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
11/03/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Heather Edgington- AdminstratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal eviction.
Facility is retaliating against resident due to a complaint filed with licensing.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jessica Cho made an unannounced subsequent visit to continue the investigation into the above allegations. LPA was greeted and granted entry by Caregiver Jasilann Kurutz and explained the reason for the visit. Administrator (Admin) Heather Edgington arrived on premise approximately 9am to assist with the investigation.

On November 16, 2021, the Department received the complaint, and the initial visit was conducted by LPAs Jenifer Tirre and Rosie Quiroz on November 23, 2021. During the course of the investigation, interviews were conducted and the following documentation were obtained during the initial visit: Physician's Report and Admission Agreement for Resident #1 (R1). On today's date, LPA Cho obtained additional documentation which includes, the Resident Rosters dated March 12, 2022 and September 9, 2025, Personnel Report, Incident Report, hospital record, eviction notice, and Stipulation for Entry of Judgement - Unlawful Detainer, and written correspondences (emails/text messages/letter) concerning R1.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
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-20211116080904
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: SHORELINE SENIOR LIVING
FACILITY NUMBER: 306005880
VISIT DATE: 11/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following: It is alleged that the the facility is illegally evicting the resident. R1 was hospitalized on August 17, 2021 per the Incident Report dated August 18, 2021. R1 was transferred to a Skilled Nursing Facility and returned to the facility on September 6, 2021. Per review of the facility's bank statement, R1 did not pay rent in September/October 2021. The eviction notice dated September 24, 2021, approved by LPA Tirre the same day at 8:11am, was issued to R1 and to R1's representative regarding nonpayment. The eviction notice met all necessary elements of the eviction procedures of the TItle 22 Regulation. R1 did not move out by October 25, 2021 so the unlawful detainer was filed on November 3, 2021 in which the court stipulation ordered R1 to backpay the rent to the facility in the amount of $8,000.00 with additional payment as an option to extend the lock out date per the court's judgement.

Regarding the allegation, Facility is retaliating against resident due to a complaint filed with licensing, it is determined that the eviction notice was issued due to nonpayment. Per review of page 13 of the admission agreement indicates that the payment is due on the 1st of each month. Page 24 of the admission agreement signed and dated by R1's representative on May 21, 2021, indicates that when a resident "is away from the facility for hospitalization... temporary placement outside this facility, the monthly rate continues" and "failure to pay this fee by the due date may result in involuntary discharge from the facility." Per review of the text messages exchanged between Admin and R1's representative, a negative Coronavirus 2019 test at the time was required to return to the facility which was not provided upon request delaying R1's return. Admin indicated that this was not a retaliatory move but a safety guideline per the Public Health.

Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the following allegations: Illegal eviction and Facility is retaliating against resident due to a complaint filed with licensing are deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Heather Edgington, and a copy of this report including the LIC811 were provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2