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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006014
Report Date: 08/06/2026
Date Signed: 08/06/2026 10:48:24 AM

Document Has Been Signed on 08/06/2026 10:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CLEMENTEFACILITY NUMBER:
306006014
ADMINISTRATOR/
DIRECTOR:		JOSHUA MARTIEZFACILITY TYPE:
740
ADDRESS:101 AVENIDA CALAFIATELEPHONE:
(949) 420-9898
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY: 80CENSUS: 32DATE:
08/06/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Jacqueline ManguilarTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced case management visit to the facility. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
A financial audit was conducted by the Department to review charges for services at the facility. The audit investigation revealed the following: Resident 1 (R1) discharged out of the facility on 01/29/2025; however, R1 was billed for parking after discharge from the facility at a rate of $200 per month for 11 months resulting in a charge of $2200. Appendix A of the admission agreement shows a fee of $100 per month for an additional parking space, not $200. Interview with R1 indicates unsuccessfully attempting to retrieve the car from the facility. Review of billing records for Resident 2 (R2) showed R2 was charged the correct daily rate, however, was charged an additional $8000 per month for services not included in the admission agreement. Administrator states the $8000 per month was an agreed upon rate with R2. Based on the admission agreement and service plan dated 02/20/2024, R2 did not require any extra assistance. Although the resident signed Appendix A, which outlined the list of services, it did not specify which services were needed by the resident. There was no documentation provided that showed what care was needed or provided by the facility resulting in a charge of $8000 per month for 15 months totaling $120,000. On 12/4/2024, R2 was billed for “Reimbursements” in the amount of $4713.88. The department was unable to determine what this charge was for. Records show R2 was billed for special maintenance in the amount of $28,382 for work that was completed on three different apartment buildings that R2 owns. Documents show that R2 signed an admission agreement on 11/27/2024 for the resident’s daughter (R3) for a daily room rate of $400 and $28 daily incontinence fee. There was no documentation provided that showed R2 had the legal authority to sign for R3 nor that these services were provided by the facility to R3. R2 was being billed for two rooms at the facility along with a room in memory care meant for R3. CONTINUED ON LIC 9099C DATED 08/06/2026
Alisa Ortiz
Kimberly Lyman
DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/06/2026
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Per resident rosters dated 01/11/2025-03/18/2025, R3 is not on the register of residents nor is there documentation of a room assigned to R3 on the signed admission agreement. During interview conducted, R3 denied ever living at the facility or spending the night.
On 12/23/2025, facility was cited for a violation of resident rights. The investigation revealed that the facility administrator had accessed the bank accounts for R1 and R2 for personal use. Records showed that Administrator Westphaln was added to R1’s account with charges for Administrator Westphaln’s credit cards, personal expenses and the purchase of a car among other items. R1 denied knowledge of such expenses and was financially abused in the amount of $266,308.39. Administrator Westphaln accessed bank accounts belonging to R2. Suspicious transactions were observed including credit purchases in retail stores and restaurants as well as a flight to Newark on 12/27/2024 with Licensee Gamburd onboard as well. R2 was financially abused in the amount of $98,693.20. As of today’s visit, facility has not completed the plan of correction due on 12/24/2025 and continues to remain in violation of Regulation 87468.1(a)(1), Personal Rights.

During the visit, LPAs toured the facility and observed the following: Facility appears clean and sanitary. LPAs observed residents dining in the dining rooms. LPAs observed ample staffing. LPAs observed the required posting of pending administrative action.



Based on the investigations conducted during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Kimberly Lyman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/06/2026 10:48 AM - It Cannot Be Edited


Created By: Kimberly Lyman On 08/06/2026 at 10:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: RAYA'S PARADISE OF SAN CLEMENTE
FACILITY NUMBER: 306006014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2026
Section Cited
HSC
1569.38(b)(1)

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A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days..: The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50. This req is not met as evidenced by:
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Licensee to notify all responsible parties, residents and Ombudsman and forward proof to LPA by POC due date.
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Based on interviews conducted, Licensee failed to notify Ombudsman and responsible parties. Two out of two responsible parties and Ombudsman deny receipt of notification which poses an immediate health and safety risk to residents 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.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Lyman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2026 10:48 AM - It Cannot Be Edited


Created By: Kimberly Lyman On 08/06/2026 at 08:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: RAYA'S PARADISE OF SAN CLEMENTE
FACILITY NUMBER: 306006014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2026
Section Cited
CCR
87507(g)(3)(B)(1)

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Payment provisions, including the following: Rate for additional items and services, including: A comprehensive description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services shall be listed. This req is not met as evidenced by:
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Licensee to audit billing practices and provide refunds as indicated. Licensee to forward proof of correction to LPA by POC due date.
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Based on record review and interviews conducted, Licensee failed to ensure additional charges were supported by the admission agreement. R1, R2, and R3 were either charged for items not on admission agreement or charged for services not provided which poses an immediate health and safety risk to residents in care.
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Type A
08/07/2026
Section Cited
CCR87468.1(a)(1)

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Residents in all residential care facilities for the elderly shall have all of the following personal rights:
To be accorded dignity in their personal relationships with staff, residents, and other persons. This req is not met as evidenced by:
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Licensee to provide refund to R1 and R2 and forward proof to LPA by POC due date.
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Based on record review and interviews conducted, Licensee failed to ensure R1 and R2 were provided dignity at the facility. Facility staff accessed resident’s bank accounts and spent the resident’s funds for personal use. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED
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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.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Lyman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
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