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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006472
Report Date: 07/16/2026
Date Signed: 07/16/2026 11:40:33 AM

Substantiated


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
01/30/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250130104434
FACILITY NAME:SAN CLEMENTE VILLAS BY THE SEAFACILITY NUMBER:
306006472
ADMINISTRATOR:PAOLI, FREDFACILITY TYPE:
740
ADDRESS:660 CAMINO DE LOS MARESTELEPHONE:
(949) 489-3400
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY:190CENSUS: 88DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kimberly Malaspina TIME COMPLETED:
10:44 AM
ALLEGATION(S):
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Thermostat's in memory care resident's rooms are not properly secure.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility to complete the investigation and deliver findings on the allegation listed above. LPA was greeted and granted entry by staff after explaining the reason for the visit.

Regarding the allegation: Thermostat in memory care resident’s rooms are not properly secure

During the investigation 6 of 7 individuals confirmed the complaint allegation. According to Executive Director Paoli, Resident 1 (R1) was found on the floor in their room with the thermostat turned all the way up. Another individual confirmed R1 turned up their thermostat and was found on the floor conscious and the room was hot. Another individual explained that other residents have adjusted the temperature on their thermostat and the facility placed covers on the thermostat once discovered residents were adjusting them.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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 3
Control Number 22-AS-20250130104434
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: SAN CLEMENTE VILLAS BY THE SEA
FACILITY NUMBER: 306006472
VISIT DATE: 07/16/2026
NARRATIVE
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The individual explained that a cover was recently placed on the thermostat in R1's room. During the investigation it was confirmed the thermostat in R1’s room was the last one without a safety cover, and the cover was not placed on the thermostat until after R1 was found on the floor of their room with the thermostat turned all the way up.

Based on the evidence gathered through interviews and document review the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. Violations are being cited per California Code of Regulations Title 22.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250130104434
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: SAN CLEMENTE VILLAS BY THE SEA
FACILITY NUMBER: 306006472
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2026
Section Cited
CCR
87307(e)(1)(A)
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87307 Personal Accommodations and Services
(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal... when residents are in proximity to or when there is use of the following items:
(1) Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. (A) Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire.
This requirement was not met as evidenced by:
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Executive Director Malaspina will confirm all 22 resident rooms in the Memory Care unit have a cover placed over the thermostat.
Executive Director Malaspina will email LPA Haley confirming all rooms have a cover by 1:00pm on the POC due date.
LPA Haley verified R1's room does have a cover over the thermostat during the visit.
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It was discovered R1 did not have a cover on their thermostat in their room. R1 was sent to the hospital after being discovered on the floor of their room and with the thermostat turned all the way up. This poses a potential 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.
SUPERVISOR'S NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3