306006014-5-14-2026-22-AS-AORZ-DU9UCL-20260520152806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006014
Report Date: 05/14/2026
Date Signed: 05/14/2026 01:50:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/24/2026 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20260424101957

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: 37	DATE:	05/14/2026
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Monica Westphaln		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff are coercing resident in care to utilize a physician not of their own choosing.
Staff are not allowing resident's representative access to documentation regarding resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the visit, LPA interviewed Administrator as well as reviewed and obtained pertinent documentation such as facility notes. Regarding the allegations that staff are coercing resident in care to utilize a physician not of their own choosing and staff are not allowing resident's representative access to documentation regarding resident in care, the investigation revealed the following: Resident 1 (R1) admitted to the facility on 06/26/2025 under Senior Docs for a physician. R1 entered into hospice care and subsequently discharged out of hospice without a physician as Responsible Party had declined the use of a Senior Doc physician. The resident was out of medications and needed to be evaluated by a physician. LPA reviewed emails between facility and responsible party where facility requested a designated physician for the resident as early as 03/31/2026. CONTINUED ON LIC 9099C DATED 05/14/2026

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

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-20260424101957

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: RAYA'S PARADISE OF SAN CLEMENTE	FACILITY NUMBER: 306006014
	VISIT DATE: 05/14/2026

NARRATIVE

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Responsible Party denied the request until the facility provided requested documents to the responsible party. Facility states providing requested documents as well as an online portal to view financial records. Responsible Party indicated requesting a Medicare care plan for hospice. While Medicare records are not the perview of the department, facility provided to LPA the hospice billing records they stated were provided to Responsible Party.
Based on records reviewed and interviews conducted, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Administrator Westphaln and a copy of this report was provided to facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

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