306006014-3-5-2026-22-AS-APAO-DSB6GQ-20260318204819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006014
Report Date: 03/05/2026
Date Signed: 03/05/2026 10:23:00 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
03/04/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260304100703

FACILITY NAME:	RAYA'S PARADISE OF SAN CLEMENTE		FACILITY NUMBER:	306006014
ADMINISTRATOR:	WESTPHALN, MONICA		FACILITY TYPE:	740
ADDRESS:	101 AVENIDA CALAFIA		TELEPHONE:	(949) 420-9898
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92672
CAPACITY:	80	CENSUS: 36	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Karla Solis, Director of Nursing		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff allow residents to smoke in non-smoking areas.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Staff #1 (S1) at 8:05am and explained the purpose of the visit.

It is alleged that Facility staff allow residents to smoke in non-smoking areas. LPA toured the facility and was told by staff that a second floor balcony, near the dining area, is designated as a smoking area. LPA did not observe any signage regarding smoking or no smoking in the patio.

LPA observed the west facing, second floor patio is between two apartments on the Assisted Living floor. Beneath the patio is the patio used by Memory Care. The adjacent apartments to the patio, #202 and #210, do not have patio access and are not able to go outside. LPA toured the facility with Director of Nursing (DON) who stated there have not been any complaints received from residents regarding smoke. LPA and DON observed the patio from the first floor. There are no signs in the facility that designate Non-Smoking/
(Continued on LIC 9099-C)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260304100703

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: RAYA'S PARADISE OF SAN CLEMENTE	FACILITY NUMBER: 306006014
	VISIT DATE: 03/05/2026

NARRATIVE

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(Continued from LIC 9099)

No Smoking" allowed; except in apartments where oxygen is in use. Currently there are no residents who use oxygen. Two residents are on hospice but are not actively using oxygen provided by hospice.

LPA interviewed five of five staff members regarding designated smoking areas. Four of five staff stated the front of the building and a second floor balcony are designated smoking areas. Staff shared that the one resident who uses the area moved into the community four months ago. One of five staff was not aware of a designated smoking area. Five of five staff confirmed there is only one resident who smokes on the second floor balcony and that most residents do not use the second floor balcony. Five of five staff have not received any complaints from residents regarding the smoker on the second floor balcony. DON stated they will address the issue at the next Resident's Council meeting and find an alternative location if this poses a problem.

LPA interviewed five of five residents. Three of five residents were unaware of a designated smoking area since they do not smoke. One of five residents does not want the upstairs balcony to be used for smoking. One of five residents was told by the Administration that the upstairs balcony can be used for smoking and that an ashtray container was provided for the resident. LPA observed the resident smoking in the patio and could not detect any smells due to the doors being closed.

Based on LPA interviews and observations, the allegation that Facility staff allow residents to smoke in non-smoking areas,.is Unfounded. The allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Director of Nursing (DON) Karla Solis, and a copy of this report and LIC 811, was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

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