Raya's Paradise of San Clemente

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced case management visit to follow up on deficiencies cited on 08/06/2026. LPAs were greeted and granted entry into the facility and explained the reason for the visit. Deficiency cited under Health and Safety Code 1569.38(b)(1) pertaining to Written Notices has NOT been cleared. Facility has thirty residents during today's visit. Facility provided nineteen written acknowledgements to LPA on 08/12/2026 confirming receipt of notification. LPAs spoke with two responsible parties and the Ombudsman and all denied receiving notification of the administrative action. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 3, 2026

Type of visit: POC

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 08/06/2026. LPAs were greeted and granted entry into the facility and explained the reason for the visit. Deficiency cited under Health and Safety Code 1569.38(b)(1) pertaining to Written Notices has NOT been cleared. Facility has thirty residents during today's visit. Facility provided nineteen written acknowledgements to LPA on 08/12/2026 confirming receipt of notification. During the visit, LPAs spoke with eight responsible parties, one self responsible resident and the Ombudsman and all denied receiving notification of the administrative action. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 18, 2026

Type of visit: Office

On this day, Regional Managers (RMs) Monica Tran and Angela Whittaker, Licensing Program Manager (LPM) Alisa Ortiz, and Licensing Program Analyst (LPA) Kimberly Lyman, conducted an office meeting with Licensee Moti Gamburd and Attorney Payam Saljoughian to discuss concerns about facility operations and the seriousness of deficiencies found during the course of investigations and case management visits at the facility. The following items were discussed during the office visit: On 04/21/2026, facility was cited for a substantiated complaint regarding resident sustaining an unexplained injury. Facility was given a civil penalty in the amount of $1000, and a Civil Penalty is pending determination by Community Care Licensing Division as per H&S Code 1569.49(f). ·On 12/23/2025, facility was cited for a substantiated complaint regarding financial abuse, not providing a resident with requested documents and not allowing a resident to leave the facility. Facility was given a $500 civil penalty. On 08/06/2026, facility was re-cited for not adhering to the plan of correction and given a $250 civil penalty for a repeat violation. As of today’s meeting, the facility has not completed the plan of correction and remains in violation. On 08/06/2026, facility was cited for billing practices and overcharges to residents. As of today’s meeting, the facility has not completed the plan of correction and remains in violation. On 08/06/2026, facility was cited for not notifying residents and responsible parties and Long Term Care Ombudsman of pending administrative action. As of today’s meeting, the facility has not completed the plan of correction and remains in violation. CONTINUED ON LIC 809C DATED 08/12/2026 Licensee agrees to the following: Licensee to request an extension in writing for POC for 87507(g)(3)(B)(1). Refund on hold pending POC due date or appeal submission. Licensee to provide proof of correction for 1569.38(b)(1). Licensee stated correcting the violation and will forward proof. 87468.1(a)(1)- Facility has submitted a second level appeal and is awaiting response. Refunds are on hold pending appeal response. An exit interview was conducted with Licensee Moti Gamburd and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Aug 12, 2026

Type of visit: Case Management - Deficiencies

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 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.the state’s words, verbatim · CDSS document, Aug 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87507(g)(3)(B)(1) · Plan of correction due date: Aug 7, 2026

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: 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.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: Licensee to audit billing practices and provide refunds as indicated. Licensee to forward proof of correction to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(1) · Plan of correction due date: Aug 7, 2026

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: 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 ASSESSEDthe state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: Licensee to provide refund to R1 and R2 and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: Aug 7, 2026

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: 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.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: Licensee to notify all responsible parties, residents and Ombudsman and forward proof to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to Raya's Paradise of San Clemente. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were allowed entry into the facility and explained the reason for the visit. Facility is licensed for 80 bedridden residents. Facility has an approved hospice waiver for 40 residents and the facility currently has 2 residents on hospice care. Administrator Monica Westphaln has an administrator certificate valid until 11/08/2026. Upon entry, facility appears clean, safe and sanitary. LPAs toured the facility at 8:27 AM along with Director of Nursing Karla Solis. LPAs toured the physical plant, checked food service, first aid kit and reviewed records. The facility consists of three stories housing an assisted living, memory care, gym, salon and multiple outside patios. Resident apartments had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPAs observed four residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 110.4 and 111.9 degrees F in all facility bathrooms tested. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Delayed egress doors in memory care are operational. Facility has multiple first aid kits with all the elements including thermometer, tweezers and scissors. LPAs observed no unsecured toxins during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility refrigerators and freezers are monitored and within temperature guidelines. LPAs observed two dining rooms serving residents. Smoke detectors and Carbon Monoxide detectors are tested by an outside company with the last inspection conducted on 07/01/2026. Fire extinguishers are fully charged. CONTINUED ON LIC 9099C DATED 07/16/2026 LPAs toured the outside grounds and there is ample shaded seating for residents in multiple patios. Emergency food and water supply was observed. The emergency disaster plan was reviewed during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 07/08/2026. Facility provides activities in the form of exercise, games, music and outings in the community. LPAs reviewed resident and staff files. Resident files contained required documents including admission agreements, physician reports, resident appraisals and orders for bed rails as indicated. Staff files reviewed contained required documentation of medical clearance, training and criminal record clearance. LPAs reviewed medication storage and administration. Medications are stored in a locked medication cart. Medications appear to be administered per physician order. Based on the observations made during today's visit, NO violations are being cited. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 16, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to deliver an amended report. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA delivered an amended report originally delivered on 12/23/2025 as well as toured the facility. LPA observed residents either eating lunch or participating in activities. No health or safety concerns noted during visit. Exit interview conducted and a copy of this report was emailed to Administrator.the state’s words, verbatim · CDSS document, May 26, 2026

Allegation investigated: 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

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 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.the state’s words, verbatim · CDSS document, May 14, 2026 · control 22-AS-20260424101957

Allegation investigated: Resident sustained an unexplained injury

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, the Department toured the facility and interviewed staff and witnesses as well as reviewed and obtained documentation such as medical records. Regarding the allegation that resident sustained an unexplained injury, the investigation revealed the following: Resident 1 (R1) was admitted into the facility on October 02, 2022. Service plan dated October 02, 2022, showed resident’s level of assistance with transferring and mobility was deemed extensive. Per R1’s physician report dated August 03, 2023, R1 had a diagnosis of Dementia and motor impairment. On June 04, 2025, the resident’s family noticed that the resident appeared to be in pain. Resident stated feeling pain in knee and family member noticed bruising on knees and toes. CONTINUED ON LIC 9099C DATED 04/21/2026 Substantiated Facility staff denied any falls had occurred. Responsible party set up a meeting with physician and an X-Ray was ordered. On June 06, 2025, the X-Ray revealed a displaced femur fracture and resident was transported to the hospital and scheduled for surgery. When family spoke to a physician assistant, they were told the fracture R1 sustained most likely resulted from a mechanical fall. On June 06, 2025, upon hospitalization, R1 was noted to have two wounds, one on the groin and the other on the right heel that had not been reported or documented by facility staff. Interviews with staff revealed it is unclear how R1 sustained a fracture while in care and the facility has no reported record of the resident falling. Four out of four staff, Director of Nursing and Administrator all deny R1 had a fall resulting in the fracture. Staff state all falls are reported and R1 had falls in the past which were reported. Staff stated they had difficulty with transfers due to the resident’s weight and the resident would require 2-3 staff for transfers. Staff 1 (S1) indicates reporting to family by text on June 04, 2025, that the resident’s knee appeared swollen. Facility did not subsequently follow up on the resident’s swollen knee nor seek medical attention. The Department reviewed R1’s medical records for June 06, 2025, through June 23, 2025. Records showed hospital documented “Suspected elder neglect” saying there is a community acquired pressure related deep tissue injury in the right heel which was discovered during admission. Resident was diagnosed with a right knee periprosthetic fracture. The treatment plan indicates R1 was to be admitted for orthopedic surgical stabilization, pain management, medical management, postoperative physical therapy and orthopedic aftercare. Per National Institute of Health (NIH), “This type of distal femur “periprosthetic” (the area immediately around an artificial body part (prosthesis or implant) fracture is usually caused by significant force on a vulnerable bone around a knee replacement, most commonly from a fall or twisting injury.” Upon Department review of records, there is no documentation of severe osteoporosis for R1 or any other condition that would, on its own, cause a fracture of this nature to occur spontaneously without trauma. NIH indicates common reasons for a fracture of this sort would be a fall directly onto the knee or onto the side with the knee twisting, a forceful twisting of the leg during transfers or major trauma such as a car accident. During staff interviews it was reported that the resident’s weight could be a reason for the fracture. However, NIH states that there would need to be significant force for this type of fracture and some sort of physical fall would almost always be involved. CONTINUED ON LIC 9099C DATED 04/21/2026 Based on the information provided such as the physician’s report, medical history information, and medical records, it was determined that the periprostatic fracture is likely to have occurred by a fall or a significant twist and not due to the resident’s weight. The preponderance of evidence standard has been met. Therefore, the allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. A Civil Penalty is pending determination by Community Care Licensing Division as per H&S Code 1569.49(f). An exit interview was conducted with Administrator and a copy of this report along with the Appeal Rights were provided at the time of this visit. incident on September 06, 2025, indicating that the resident had a swollen knee which resulted in the fracture. Facility indicated in the report that the fracture was due to the resident’s weight and not a fall. The report indicates there was no bruising, however the medical records show the resident had swelling and bruising on right knee and thigh. Records reviewed could not confirm when the fall occurred thus the Department is unable to determine if the authorized representative was notified timely or if medical attention was sought timely. Based on record review and interviews conducted, the Department 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, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Apr 21, 2026 · control 22-AS-20250609081414

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Apr 22, 2026

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This req is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee failed to ensure care and supervision was provided to R1. R1 sustained an unexplained fracture as well as pressure injury while in care which poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, Apr 21, 2026

Plan of correction: Licensee to provide an in-service on care and supervision including transfers and forward proof to LPA by POC due date.

Allegation investigated: Resident was neglected leading to hospitalization Facility failed to report incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry by Executive Director Joshua Martinez and explained the reason for the visit. During the course of the investigation, the Department toured the facility and interviewed staff and witnesses as well as reviewed and obtained documentation such as Hospital medical records. Regarding the allegations that resident was neglected leading to hospitalization and facility failed to report incident, the investigation revealed the following: Resident 1 (R1) admitted into the facility on September 25, 2024, with a known history of suicide attempt. On September 28, 2024, R1 was found lying on the ground outside the patio balcony on the second floor. R1 was complaining of pain to hip and knee. 911 was called and the resident was transported to the Hospital. First responders indicated that R1 had landed on their feet and fell backward. It was unknown if they had lost consciousness. The hospital admitting diagnoses included fractures to the vertebrae and femur and hemorrhages. Per hospital records, R1 suffered a fall from a height of greater than 3 feet and CONTINUED ON LIC 9099C DATED 03/18/2026 Unsubstantiated was listed as a suicide attempt. Hospital narrative indicates R1 has a history of schizophrenia, depression, anxiety and history of suicide attempt by jumping .Resident was admitted to the hospital and subsequently admitted into a skilled nursing facility for rehabilitation. R1 did not return to the facility after the stay at skilled nursing. Interview with facility Administrator (AD) Monica Westphaln indicates the resident was evaluated and cleared by R1’s physician and Nurse Practitioner Psychiatrist for suitability for admission into the facility. R1’s physician confirmed evaluating the resident to ensure the resident was stable before signing off on admission. Per interview conducted, R1’s physician felt the facility was not to blame for R1’s suicide attempt as they do not believe R1’s behavior could have been predicted by the facility given they were deemed suitable for admission. During the investigation it was determined that while the facility utilizes video surveillance in common areas of the facility, the Administrator denied there was footage available. Interview with a facility staff member stated viewing the footage and observing nothing on the footage at that time. Facility staff interviewed confirmed status checks are done on residents every two hours. Four out of five staff interviewed stated that status checks were conducted on R1. Staff stated that R1 had been displaying unusual behavior prior to the fall and medication was being used to minimize their agitation and strange behaviors. A self reported incident report was submitted to the Department on October 3, 2024, indicating that R1 had been found on the floor after a fall with knee and hip pain. There were no further details included in the report. Two out of three staff and one witness confirm being told by facility staff or management that R1 had jumped off the balcony. One staff member indicated being told by Administrator to say R1 had fallen rather than jumped. Administrator denies the resident jumped off the balcony. Due to conflicting information, the Department is unable to corroborate the allegations Resident was neglected leading to hospitalization and facility failed to report incident. 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, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Mar 18, 2026 · control 22-AS-20250317161350

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety case management visit to the facility. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and spoke with residents in memory care and assisted living. Residents were observed relaxing or participating in activities and appeared clean and well taken care of. Facility appears clean, safe and sanitary. LPA observed ample staffing in the memory care unit. LPA observed ample two day perishables and seven day non-perishables as well as emergency food and water. LPA observed no health or safety concerns during the visit today. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026

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

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 (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.the state’s words, verbatim · CDSS document, Mar 5, 2026 · control 22-AS-20260304100703

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety case management visit to the facility. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and spoke with residents. Residents were observed relaxing or dining in the facility and appeared clean and well taken care of. Facility appears clean, safe and sanitary. LPA observed ample staffing in the memory care unit. LPA observed no health or safety concerns during the visit today. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 15, 2026

Allegation investigated: Staff is financially abusing resident Staff are not allowing resident to leave the facility Staff are not providing resident with requested documents

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced complaint visit to deliver findings on the above allegations. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, the Department interviewed staff, residents and witnesses as well as reviewed and obtained documentation including bank statements. Regarding the allegation that Staff is financially abusing resident, the investigation revealed the following: Resident 1 (R1) was admitted into the facility on June 14, 2023, with an initial assessment indicating R1 had no Dementia diagnosis; is able to leave the facility unassisted and was responsible for self. On June 19, 2023 , R1 had a Durable Power of Attorney (DPOA) signed in which their DPOA was assigned to facility Administrator/Chief Financial Officer (CFO) Monica Westphaln. A second DPOA was completed dated September 06, 2024, which showed the appointment of Professional Fiduciary Jeffey Siegle as R1’s DPOA. Per interview with R1, they had no knowledge of Jeffrey Siegle’s appointment. On January 28, 2025, CONTINUED ON LIC 9099C DATED 12/23/2025 Substantiated the facility obtained an updated physician assessment which diagnosed R1 with Dementia and stated they were unable to leave the facility unassisted. That same day, R1 moved to another licensed facility and received a new medical assessment showing R1 did not have Dementia and was able to manage their own affairs. Resident 2 (R2) was admitted into the facility on February 08, 2024. Per physician report dated February 04, 2024, R1 has a diagnosis of Dementia and is unable to leave the facility unassisted. DPOA for R2 designates financial Fiduciary Jeffrey Siegle as the agent for resident; however, R2 denies knowledge of the agent. Bank statements for R1 were subpoenaed for San Diego Credit Union Bank (SDCU) and U.S Bank (USB). In July of 2023, Westphaln was added to R1’s SDCU account as the trustee. On July 28, 2023, a $100K check from R1’s US Bank checking account was made payable to CFO Westphaln with no memo regarding what the check was issued for. On August 2, 2024, Westphaln deposited a check for $25K to the US bank joint account. The check was made payable to herself and check images obtained showed the check is from Westphaln’s personal Capital One account. Based on the information and documentation available, the $100K check was deposited into Westphaln’s Capital One checking account and then later transferred back $25K into the joint account at US Bank. Per bank records subpoenaed and information available, on August 8, 2023, Westphaln added R1 to the her money market account with U.S bank and their primary address was listed as same as Westphaln’s personal address. On November 21, 2023, and March 13, 2024, an additional $25K and $480K were deposited. Funds transferred were from R1’s SDCU account. In total, R1 funded this joint account approximately $605K. Per records reviewed, multiple suspicious transactions and activities were observed including: checks written and signed by Westphaln paid to various individuals and vendors whom R1 had no knowledge of; electronic withdrawals to pay various credit card payments for Westphaln’s personal expenses; and payments made to the County of Orange for Westphaln’s home address. Multiple checks were made out for home repairs for R1’s home in the amount of $61,876. Upon interview, R1 denied knowledge of the vendors paid or authorizing the checks. Additionally, Witnesses and R1 state the repairs to R1’s home were never done. Electronic payments were made to Wells Fargo, Chase, American Express credit cards, and payment to Hyundai Motor Finance for $24,299.03. R1 denied purchasing a Hyundai vehicle as well as owning credit cards with the aforementioned companies. Per R1, they only have one credit card with Discover. Financial records for R2 were subpoenaed, reviewed and analyzed for the period between January 2024 to April 2025. Upon review, suspicious transactions were observed including multiple credit purchases made in retail shops, stores and restaurants in the town where Westphaln’s primary’s residence is located at and surrounding areas. The suspicious purchases on R2’s statements were reviewed by R2 and their attorney who denied the purchases were made by R2. It was revealed that dozens of purchases were fraudulently made including purchases to high end stores in amounts ranging from $1000 to $8000; grocery store purchases; and payments made to a physician in which R2 had no knowledge of. Bank statements showed that Westphaln had used multiple Chase credit cards belonging to R2 to make personal purchases and transferred money from R2’s Bank of America account to pay for the purchases. R2’s Chase Account noted funds had been used to purchase Crypto coin. Per R2 and witness, the purchase of Crypto coin was not authorized. Emails obtained from R2’s personal email account revealed flight tickets purchased using 896,500 miles redeemed on R2’s Chase credit card. The tickets purchased were for a round trip flight from Los Angeles International Airport to Newark for the dates of December 27, 2024, through January 02, 2025. Per email confirmation obtained, the flight miles were redeemed for the following individuals: CFO Monica Westphaln, Licensee Moti Gamburd; Licensee’s family members Raissa Gamburd & Michelle Raz and Dr. Elaine Treystman. The retail price of the miles redeemed was estimated to be approximately $10,490.55. Per review of facility LIC 400 Affidavit Regarding Client/Resident Cash Resources, the facility will not handle resident’s cash resources. Based on subpoenaed bank records reviewed and interviews conducted, Westphaln financially abused R1 by various means totaling $266,308.39 & R2 was financially abused by various means totaling $98,693.20. Regarding the allegations that staff are not allowing residents to leave the facility and staff are not providing resident with requested documents, the investigation revealed the following: Documentation and interviews with resident and witnesses indicated R1 had been blocked from leaving the facility on multiple occasions from July 24, 2024, through January 23, 2025. On January 21, 2025, R1 was restricted from leaving with a visitor, after staff stated the resident could not leave due to having a DPOA. The DPOA, Jeffrey Siegle, was called around 12:00 PM and advised that R1 could leave. Despite this, R1 was still prevented from leaving by facility staff. At approximately 1:45 PM, R1 was finally allowed to leave the facility by staff. On January 22, 2025, R1 was not allowed to leave the facility with a visitor once again due to the wishes of the DPOA per management of the facility. On January 23, 2025, R1 attempted to leave the facility with a visitor and was again told the resident would be unable to leave. R1 and visitor met with the Ombudsman who informed facility staff that the R1 could leave per personal rights regulations. R1 was subsequently allowed to leave with the visitor. Seven out of nine witnesses state facility management regularly prohibited R1 from leaving the facility with visitors. It was alleged Staff are not providing resident with requested documents. It was reported R1 requested their personal documents documents such as their facility contract and their financial records from Administrator Westphaln multiple times after she began handling R1’s finances. CONTINUED ON LIC 9099C DATED 12/23/2025 R1 reported Administrator Westphaln failed to provide a copy of their trust book in which Administrator. Westphaln was appointed as R1’s trustee. Witnesses interviewed reported having knowledge of R1’s reports about requesting documents from Administrator Westphaln and the failure to provide the requested items. During the January 22, 2025, incident in which R1 was not allowed to leave, a witness reported R1 requested a copy of their Power of Attorney (POA) paperwork from Administrator Scott Self who refused to comply. The following day, the witness reported that R1 put in a request with the front desk for a copy of their trustbook to which R1 later reported they never received. On January 24, 2025, at R1’s request, a written list was compiled of items being requested and provided to the front desk with the instructions it be given to Administrator Westphaln and Licensee Moti Gamburd. R1 later checked in with the front desk that same day who confirmed giving the request to Administrator Westphaln and Licensee Gamburd. R1 reported never receiving the requested items from the facility Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the following allegations are deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. *This is an amended reportthe state’s words, verbatim · CDSS document, Dec 23, 2025 · control 22-AS-20250122140204

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Dec 24, 2025

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: 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 ASSESSEDthe state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide the plan to provide refunds to R1 and R2 and forward to LPA by POC due date. This is an amended report

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Dec 24, 2025

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure R1 was allowed to leave the facility. Facility staff prohibited R1 from leaving the facility with visitors. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide an in-service to all staff regarding resident rights including the ability to leave the facility and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(21) · Plan of correction due date: Jan 7, 2026

Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided. This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure that R1 was provided requested documents which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide an in-service on resident's access to records and forward proof to LPA by POC due date.

Allegation investigated: Staff is financially abusing resident Staff are not allowing resident to leave the facility Staff are not providing resident with requested documents

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced complaint visit to deliver findings on the above allegations. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, the Department interviewed staff, residents and witnesses as well as reviewed and obtained documentation including bank statements. Regarding the allegation that Staff is financially abusing resident, the investigation revealed the following: Resident 1 (R1) was admitted into the facility on June 14, 2023, with an initial assessment indicating R1 had no Dementia diagnosis; is able to leave the facility unassisted and was responsible for self. On June 19, 2023 , R1 had a Durable Power of Attorney (DPOA) signed in which their DPOA was assigned to facility Administrator/Chief Financial Officer (CFO) Monica Westphaln. A second DPOA was completed dated September 06, 2024, which showed the appointment of Professional Fiduciary Jeffey Siegle as R1’s DPOA. Per interview with R1, they had no knowledge of Jeffrey Siegle’s appointment. On January 28, 2025, CONTINUED ON LIC 9099C DATED 12/23/2025 Substantiated the facility obtained an updated physician assessment which diagnosed R1 with Dementia and stated they were unable to leave the facility unassisted. That same day, R1 moved to another licensed facility and received a new medical assessment showing R1 did not have Dementia and was able to manage their own affairs. Resident 2 (R2) was admitted into the facility on February 08, 2024. Per physician report dated February 04, 2024, R1 has a diagnosis of Dementia and is unable to leave the facility unassisted. DPOA for R2 designates financial Fiduciary Jeffrey Siegle as the agent for resident; however, R2 denies knowledge of the agent. Bank statements for R1 were subpoenaed for San Diego Credit Union Bank (SDCU) and U.S Bank (USB). In July of 2023, Westphaln was added to R1’s SDCU account as the trustee. On July 28, 2023, a $100K check from R1’s US Bank checking account was made payable to CFO Westphaln with no memo regarding what the check was issued for. On August 2, 2024, Westphaln deposited a check for $25K to the US bank joint account. The check was made payable to herself and check images obtained showed the check is from Westphaln’s personal Capital One account. Based on the information and documentation available, the $100K check was deposited into Westphaln’s Capital One checking account and then later transferred back $25K into the joint account at US Bank. Per bank records subpoenaed and information available, on August 8, 2023, Westphaln added R1 to the her money market account with U.S bank and their primary address was listed as same as Westphaln’s personal address. On November 21, 2023, and March 13, 2024, an additional $25K and $480K were deposited. Funds transferred were from R1’s SDCU account. In total, R1 funded this joint account approximately $605K. Per records reviewed, multiple suspicious transactions and activities were observed including: checks written and signed by Westphaln paid to various individuals and vendors whom R1 had no knowledge of; electronic withdrawals to pay various credit card payments for Westphaln’s personal expenses; and payments made to the County of Orange for Westphaln’s home address. Multiple checks were made out for home repairs for R1’s home in the amount of $61,876. Upon interview, R1 denied knowledge of the vendors paid or authorizing the checks. Additionally, Witnesses and R1 state the repairs to R1’s home were never done. Electronic payments were made to Wells Fargo, Chase, American Express credit cards, and payment to Hyundai Motor Finance for $24,299.03. R1 denied purchasing a Hyundai vehicle as well as owning credit cards with the aforementioned companies. Per R1, they only have one credit card with Discover. Financial records for R2 were subpoenaed, reviewed and analyzed for the period between January 2024 to April 2025. Upon review, suspicious transactions were observed including multiple credit purchases made in retail shops, stores and restaurants in the town where Westphaln’s primary’s residence is located at and surrounding areas. The suspicious purchases on R2’s statements were reviewed by R2 and their attorney who denied the purchases were made by R2. It was revealed that dozens of purchases were fraudulently made including purchases to high end stores in amounts ranging from $1000 to $8000; grocery store purchases; and payments made to a physician in which R2 had no knowledge of. Bank statements showed that Westphaln had used multiple Chase credit cards belonging to R2 to make personal purchases and transferred money from R2’s Bank of America account to pay for the purchases. R2’s Chase Account noted funds had been used to purchase Crypto coin. Per R2 and witness, the purchase of Crypto coin was not authorized. Emails obtained from R2’s personal email account revealed flight tickets purchased using 896,500 miles redeemed on R2’s Chase credit card. The tickets purchased were for a round trip flight from Los Angeles International Airport to Newark for the dates of December 27, 2024, through January 02, 2025. Per email confirmation obtained, the flight miles were redeemed for the following individuals: CFO Monica Westphaln, Licensee Moti Gamburd; Licensee’s family members Raissa Gamburd & Michelle Raz and Dr. Elaine Treystman. The retail price of the miles redeemed was estimated to be approximately $10,490.55. Per review of facility LIC 400 Affidavit Regarding Client/Resident Cash Resources, the facility will not handle resident’s cash resources. Based on subpoenaed bank records reviewed and interviews conducted, Westphaln financially abused R1 by various means totaling $266,308.39 & R2 was financially abused by various means totaling $98,693.20. Regarding the allegations that staff are not allowing residents to leave the facility and staff are not providing resident with requested documents, the investigation revealed the following: Documentation and interviews with resident and witnesses indicated R1 had been blocked from leaving the facility on multiple occasions from July 24, 2024, through January 23, 2025. On January 21, 2025, R1 was restricted from leaving with a visitor, after staff stated the resident could not leave due to having a DPOA. The DPOA, Jeffrey Siegle, was called around 12:00 PM and advised that R1 could leave. Despite this, R1 was still prevented from leaving by facility staff. At approximately 1:45 PM, R1 was finally allowed to leave the facility by staff. On January 22, 2025, R1 was not allowed to leave the facility with a visitor once again due to the wishes of the DPOA per management of the facility. On January 23, 2025, R1 attempted to leave the facility with a visitor and was again told the resident would be unable to leave. R1 and visitor met with the Ombudsman who informed facility staff that the R1 could leave per personal rights regulations. R1 was subsequently allowed to leave with the visitor. Seven out of nine witnesses state facility management regularly prohibited R1 from leaving the facility with visitors. It was alleged Staff are not providing resident with requested documents. It was reported R1 requested their personal documents documents such as their facility contract and their financial records from Administrator Westphaln multiple times after she began handling R1’s finances. CONTINUED ON LIC 9099C DATED 12/23/2025 R1 reported Administrator Westphaln failed to provide a copy of their trust book in which Administrator. Westphaln was appointed as R1’s trustee. Witnesses interviewed reported having knowledge of R1’s reports about requesting documents from Administrator Westphaln and the failure to provide the requested items. During the January 22, 2025, incident in which R1 was not allowed to leave, a witness reported R1 requested a copy of their Power of Attorney (POA) paperwork from Administrator Scott Self who refused to comply. The following day, the witness reported that R1 put in a request with the front desk for a copy of their trustbook to which R1 later reported they never received. On January 24, 2025, at R1’s request, a written list was compiled of items being requested and provided to the front desk with the instructions it be given to Administrator Westphaln and Licensee Moti Gamburd. R1 later checked in with the front desk that same day who confirmed giving the request to Administrator Westphaln and Licensee Gamburd. R1 reported never receiving the requested items from the facility Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the following allegations are deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. *This is an amended reportthe state’s words, verbatim · CDSS document, Dec 23, 2025 · control 22-AS-20250122140204

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Dec 24, 2025

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: 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 ASSESSEDthe state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide the plan to provide refunds to R1 and R2 and forward to LPA by POC due date. This is an amended report

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Dec 24, 2025

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure R1 was allowed to leave the facility. Facility staff prohibited R1 from leaving the facility with visitors. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide an in-service to all staff regarding resident rights including the ability to leave the facility and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(21) · Plan of correction due date: Jan 7, 2026

Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided. This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure that R1 was provided requested documents which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide an in-service on resident's access to records and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced case management in conjunction with complaint investigation 22-AS-20250122140204. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the complaint investigation, LPA interviewed staff, residents and witnesses as well as reviewed records. Information garnered during the investigation shows multiple violations of Department regulations occurred at the facility under the oversight of the Licensee which included financial abuse and infringement of resident personal rights. Based on interviews conducted and record review, the following violation is 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 Administrator Westphaln.the state’s words, verbatim · CDSS document, Dec 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: Dec 24, 2025

The licensee..., shall exercise general supervision over the affairs of the licensed facility.. concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This req is not met as evidenced by: Based on record review and interviews conducted, the licensee failed to ensure oversight was provided for facility operations resulting in multiple resident’s being financially abused and personal rights being violated.This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to forward a detailed written plan showing how the Licensee will provide oversight at the facility to prevent violations of department regulations.

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20250122140204. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPAs toured the facility and spoke with residents. Residents were observed relaxing or dining in the facility and appeared clean and well taken care of. Facility appears clean, safe and sanitary. LPAs observed ample staffing in the memory care unit. LPAs observed no health or safety concerns during the visit today. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 23, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to the facility. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and spoke with residents. Residents were observed relaxing or dining in the facility and appeared clean and well taken care of. Facility appears clean, safe and sanitary. LPA observed ample staffing in the memory care unit. LPA observed no health or safety concerns during the visit today. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 19, 2025

Allegation investigated: Facility did not adhere to the admission agreement Facility did not provide refund

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as billing invoices. Regarding the allegations that facility did not adhere to the admission agreement and facility did not provide refund, the investigation revealed the following: Admission agreement for Residents #1 and 2 (R1, R2) signed on 06/26/2023 indicate room rate is locked in for two years. Facility raised the room rate from $200 per day to $210 per day from August 2024 to December 2024. After Responsible Party brought it to the facility’s attention, facility adjusted the invoices. However, a refund/ credit did not appear on any of the invoices reviewed by LPA. Responsible Party adjusted payment to reflect the amount estimated to be overpaid. CONTINUED ON LIC 9099C DATED 11/06/2025 Substantiated Facility did not provide evidence of accurate accounting related to the overcharge. Admission agreement shows laundry services to be done once per week. LPA reviewed invoices for laundry services 4-7 times a week dated 02/01-04/01/2025 in the amount of $200 per month. These charges were unauthorized by the financial DPOA. Based on records reviewed and interviews conducted, the preponderance of evidence has been met, therefore the allegations are deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Westphaln and a copy of this report along with the Appeal Rights were provided at the time of this visit. there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator Westphaln and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 22-AS-20250605144944

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Nov 20, 2025

The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This req is not met as evidenced by: Based on record review, Licensee failed to ensure admission agreement was followed. R1 and R2's room rate was increased after 1 year when admission agreement stated increases after 2 years. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee revised billing system effective 01/2026.Licensee to forward letter to be sent to residents about change in system as well as information regarding the new system to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Nov 20, 2025

In addition to the rights... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To be free from... financial exploitation... humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This req is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to provide a refund to R1/ R2 which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee to audit invoices and provide a refund to residents as necessary. Licensee to forward proof to LPA by POC due date.

Allegation investigated: Sexual abuse

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, the Department interviewed staff, resident and witnesses as well as reviewed and obtained documentation including physician report. Regarding the allegation of sexual abuse, the investigation revealed the following: On June 06, 2025, Resident 1 (R1) was admitted to Kaiser Permanente for an unexplained fracture. Per physician report dated August 03, 2023, resident is diagnosed with Dementia with confusion. Per the hospital Social Worker, R1 is oriented to self only. On June 15, 2025, while hospitalized, R1 reported that a male caregiver had touched them; slept with them; and inserted something into their buttocks. No other details or descriptions were provided. R1 did not report the incident upon admission to the hospital but rather 10 days later during a family visit. CONTINUED ON LIC 9099C DATED 11/06/2025 Unsubstantiated Prior to R1’s surgery for the fracture, doctors had difficulty inserting a catheter due to swelling in the vaginal area which could be due to incontinence. Per the hospital medical records, a large hematoma formed in R1’s groin area and was suspected to be caused by the fracture or possible sexual abuse. R1’s family filed a police report on the evening of June 15, 2025. Due to the delay in reporting the incident and the resident’s condition, R1’s family declined to consent to a sexual abuse exam. Interview with R1’s family indicated a family member was usually at the facility during incontinence care to supervise. The department attempted to interview R1 but was unsuccessful due to cognitive decline. One out of one memory care residents denied any abuse occurring at the facility. On June 15, 2025, Orange County Sheriff’s office conducted a visit to the facility to investigate the allegation. Through interviews, records and video surveillance, the detective determined that a sexual assault had not occurred, and the resident’s family concurred with the detective. The case was closed OC Sheriff’s office. The Department interviewed facility staff as well as obtained written statements from staff at the facility. Four out of four staff interviewed and eight out of eight statements by staff deny any sexual abuse occurring at the facility. Based on interviews conducted, the Department is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator Westphaln and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 22-AS-20250616105004

Allegation investigated: Facility staff did not seek medical attention for resident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate the investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed Administrator and resident as well as reviewed and obtained pertinent documentation such as hospice notes. Regarding the allegation that facility staff did not seek medical attention for resident, the investigation revealed the following: Per physician report dated 08/21/2024, Resident 1 (R1) is diagnosed with Multiple Sclerosis. Resident is on hospice care with Acacia Hospice and has a wound on the sacrum. Per hospice documentation, R1 is being seen for wound care every 1-2 days. Interview with resident confirmed resident is being seen for wound care nearly daily and stated satisfaction with the care being provided. Per facility documentation, resident is being repositioned and checked every 2 hours as directed by hospice. Facility notes show resident's bandage being replaced by facility staff when soiled. Based on interviews conducted and record review, The allegation is deemed UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was left at the facility. Unfoundedthe state’s words, verbatim · CDSS document, Oct 23, 2025 · control 22-AS-20251017151548

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to deliver an amended report. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA delivered an amended report for complaint #22-AS-20250228162254 initially delivered on 07/01/2025. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to the facility for the purpose of delivering complaint reports which had a date glitch when delivered on 08/14/2025. Complaint investigation 22-AS-20250729114024 report was delivered with a date of 08/12/2025 and complaint investigation 22-AS-20250218082756 had a date of 08/06/2025. Both reports were delivered today with the correct date of 08/14/2025. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 18, 2025

Allegation investigated: Resident developed pressure injuries while in care

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as facility progress notes. Resident 1 (R1) was admitted under Geiss Hospice 10/31/2023 with a diagnosis of Alzheimer's Disease. Per hospice summary and facility progress notes, resident had no noted pressure injuries until 02/12/2025. Interview with Hospice Nurse indicated resident had some flaking on the behind which was not open or excoriated. Nurse indicated resident was clean and dry at every visit. Nurse stated training staff on repositioning at every visit. Three out of three staff interviewed confirmed resident was being repositioned every two hours however facility does not document repositioning. Resident was seen by physician or hospice nearly every day at end of life. Resident passed away on 02/18/2025. Based on record review and interview, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, CONTINUED ON LIC 9099C DATED 08/14/2025. Unsubstantiated meaning that although the allegation 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 and a copy of this report was provided to facility. Therefore, the allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Westphaln and a copy of this report along with the Appeal Rights were provided at the time of this visit.the state’s words, verbatim · CDSS document, Aug 14, 2025 · control 22-AS-20250218082756

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Aug 15, 2025

The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This req is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1's Morphine Sulfate was in a safe and locked place. The medication was inadvertently given to R2's family. This poses an immediate health and safety risk to resident's in care.the state’s words, verbatim · CDSS document, Aug 14, 2025

Plan of correction: Licensee to provide an in-service regarding resident discharge medication and forward proof to LPA by POC due date.

Allegation investigated: Staff are inappropriately disposing of residents medication

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as Centrally Stored Medication and Destruction Record. Regarding the allegation that staff are inappropriately disposing of residents medication, the investigation revealed the following: Facility is using the department's Centrally Stored Medication and Destruction Record (CSMDR) however there is no documentation of two signatures observing medication destruction. Facility policy on medication disposition states medications will be destroyed by a licensed nurse or pharmacist with a witness present. Two out of two staff confirm facility LVN is destructing the medications without a witness signature. LPA observed the destruction process as well as CSMDR during the investigation. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. CONT ON LIC 9099C DATED 08/14/2025 Substantiated An exit interview was conducted with Administrator and a copy of this report along with the Appeal Rights were provided at the time of this visitthe state’s words, verbatim · CDSS document, Aug 14, 2025 · control 22-AS-20250729114024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i) · Plan of correction due date: Aug 28, 2025

Prescription medications which are not taken with the resident upon termination of services.. or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years..This req is not met as evidenced by: Based on record review and interview, Licensee failed to ensure medication destruction is occurring with facility administrator and another adult and including two signatures. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 14, 2025

Plan of correction: Licensee has developed paperwork to document the medication destruction. Licensee to forward revised medication destruction process to LPA by POC due date

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20250218082756. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the complaint investigation, LPA observed that incident involving missing Morphine in October 2024 noted in the complaint was not reported to the department. Based on the observations made during today's visit, the following violation is 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 Administrator Westphaln.the state’s words, verbatim · CDSS document, Aug 14, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 28, 2025

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: Any incident which threatens the welfare, safety or health of any resident...This requirement is not met as evidenced by: Based on record review, Licensee failed to ensure incident regarding missing Morphine IN October 2024 was reported to the department. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 14, 2025

Plan of correction: Licensee to read regulation and provide a statement of understanding and forward proof to LPA by POC due date.

Allegation investigated: Staff did not safeguard residents personal items

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and witness as well as reviewed and obtained pertinent documentation such as Resident Inventory Form. Regarding the allegation that staff did not safeguard residents personal items, the investigation revealed the following: It was reported that Resident 1 (R1) put Resident 2's (R2) ring on and the ring was too tight to remove. Orange County Fire Authority was called and the ring was cut off of the resident's finger. The ring was not returned to R1's family until after the resident's death. Three out of three witnesses confirm compensation for the damaged ring was not provided to the family. Administrator indicates advising family to remove the ring from the resident's room prior to the incident due to the value. However, the ring is noted to be on the Resident Inventory Form dated 07/06/2024 and on the updated form dated 09/26/2024. Based on interviews conducted, CONTINUED ON LIC 9099C DATED 08/06/2025 Substantiated the preponderance of evidence has been met, therefore the allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Westphaln and a copy of this report along with the Appeal Rights were provided at the time of this visit. Facility nurse states Atorvastatin Calcium Oral Tablet 40MG was delivered and logged in by staff without notifying nurse. Facility does not document individual medication orders being delivered. Per review of Medication Administration Record (MAR), resident missed no doses of the medication. LPA toured the memory care unit on two different occasions and observed the memory care couch to be clean and free of odor. It was alleged facility did not provide comfortable accommodations due to the alleged odor of the couch. Facility indicates cleaning the covers on the couch a minimum of every three days and has back up covers as well as a machine to clean the couch. Facility provided documentation of multiple purchases for new couch covers. Based on observation and interview, 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.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 22-AS-20250625143358

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Aug 20, 2025

Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. Based on interviews conducted, Licensee failed to ensure R2's ring was safeguarded. R1 put R2's ring on and had to be cut off. Licensee did not compensate R2's family for the loss. This poses a potential health and safety risk to resident's in care.the state’s words, verbatim · CDSS document, Aug 6, 2025

Plan of correction: Licensee to conduct an in-service with staff on safeguarding resident's belongings and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20250625143358. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, it was reported that R1's family did not receive the final refund after the resident's death until 06/06/2025. LPA reviewed correspondence between the facility and responsible party dated 05/19/2025 indicating the refund had not been made. Resident's belongings were moved out of the facility on 04/21/2025. Based on the observations made during today's visit, the following violation is 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 Administrator Westphaln.the state’s words, verbatim · CDSS document, Aug 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Aug 20, 2025

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to... to the resident’s estate, within 15 days after the personal property is removed. This req is not met as evidenced by: Based on record review, Licensee failed to ensure a refund was paid to R1's family within 15 days of R1's belongings being removed after death. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2025

Plan of correction: Licensee to review the regulation and forward a statement of understanding to LPA by POC due date.

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 07/24/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Bed rail has been removed. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87405(a) pertaining to Administrator Qualifications has been cleared. Licensee provided LIC 308's. Licensee complied with the POC. Deficiency cited under Title 22 Regulation 87411(c)(1) pertaining to First Aid Training has been cleared. Licensee has complied with the POC. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Required - 1 Year

Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Raya's Paradise of San Clemente. The purpose of today’s visit was to conduct the Annual Required inspection. LPM and LPA were allowed entry into the facility and explained the reason for the visit. Facility is licensed for 80 bedridden residents. Facility has an approved hospice waiver for 40 residents and the facility currently has 2 residents on hospice care. Administrator Monica Westphaln has an administrator certificate valid until 11/08/2026. LPM and LPA met with Vladimir Estrin to gather staff and resident documents. Vladimir indicated being a third party vendor. Upon record review, there is no fingerprint clearance for Vladimir Estrin. LPM and LPA toured the facility at 8:29 AM along with Receptionist Jacqueline Manguilar. LPM and LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The facility consists of three stories housing an assisted living, memory care, gym, salon and multiple outside patios. Resident apartments had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPM and LPA observed four residents with a half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.2 and 110 degrees F in all facility bathrooms tested. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Delayed egress doors in memory care are operational. Facility has multiple first aid kits with all the elements including thermometer, tweezers and scissors. LPM and LPA observed no unsecured toxins during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility refrigerators and freezers are monitored and within temperature guidelines. LPM and LPA observed two dining rooms serving residents. Smoke detectors and Carbon Monoxide detectors are tested by an outside company with the last inspection conducted on 07/05/2024. Fire extinguishers are fully charged. LPM and LPA toured the outside grounds and there is ample shaded seating for residents in multiple patios. Emergency food and water supply was observed. CONT ON LIC809-C DATED 07/24/2025 The emergency disaster and infection control plans were reviewed during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 07/01/2025. Facility provides activities in the form of exercise, games, music and outings in the community. LPA reviewed resident and staff files. Resident files contained required documents including admission agreements, physician reports, resident appraisals and orders for bed rails for three out of four residents. Staff files reviewed contained required documentation of medical clearance, training and criminal record clearance. LPA reviewed medication storage and administration. Medications are stored in a locked medication cart. Medications are being administered per physician order. Based on the observations made 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 Kelly Brady.the state’s words, verbatim · CDSS document, Jul 24, 2025

Allegation investigated: Resident was denied visitors

Licensing Program Analyst (LPA) Kimberly Lyman and Licensing Program Manager (LPM) Alisa Ortiz conducted an unannounced complaint visit to deliver findings on the above allegation. LPA and LPM were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff, resident and witnesses. Regarding the allegation that resident was denied visitors, the investigation revealed the following: It was reported that Resident 1's (R1) family member was denied visitation at the facility after being allowed prior visitation weekly. Interviews conducted with three out of four witnesses deny visitation was blocked for the family member. R1's family member denies being blocked from visitation; However, two witnesses state visitors in general would be prevented from visiting R1. LPA conducted interview with R1 who denied witnessing family member being turned away and had no personal knowledge of the incident. LPA was unable to verify any specific dates or times of alleged incidents. Based on interviews conducted, LPA is unable to corroborate the allegation. CONTINUED ON LIC 9099C DATED 07/24/2025. Unsubstantiated Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kelly Brady and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Jul 22, 2025 · control 22-AS-20250318170616

Allegation investigated: Staff served as resident’s agent under a power of attorney

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff, resident and witness as well as reviewed and obtained pertinent documentation such as Durable Power of Attorney (DPOA) paperwork. Regarding the allegation that staff served as resident’s agent under a power of attorney, the investigation revealed the following: Resident 1 (R1) indicated that Facility Administrator had recommended becoming the resident's DPOA due to an upcoming surgery scheduled for the resident. Resident states declining the recommendation but eventually agreed. Resident states being very ill during the signing of the document and was surprised to subsequently see an additional person as a back-up designee and prospective conservator. The back up agent and prospective conservator was listed as Jeffrey Siegle. Resident indicates the prospective conservator was not requested by the resident and gave clear instructions that the DPOA was only for the purpose of the time of the surgery. CONTINUED ON LIC 9099C DATED 07/01/2025 Substantiated LPA reviewed the document showing Facility Administrator Monica Westphaln as the healthcare power of attorney for the resident signed 02/07/2025 with a back-up designee and prospective conservator Jeffrey Siegle. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the following allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with facility representative and a copy of this report along with the Appeal Rights were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20250303090520

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87217(d)(2) · Plan of correction due date: Jun 21, 2025

Except as provided in approved continuing care agreements, no licensee or employee of a facility shall: accept any general or special power of attorney for any such person; This req is not being met as evidenced by: Based on record review and interview, Licensee failed to ensure an employee of the facility was not designated as a power of attorney for R1. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: Licensee to read the regulation and forward a statement of understanding to LPA by POC due date.

Allegation investigated: Staff did not prevent resident from leaving the facility unassisted

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that staff did not prevent resident from leaving the facility unassisted, the investigation revealed the following: On 03/04/2025, Resident 1 (R1) was picked up unaccompanied at the community by a driver for another assisted living facility, The Seville. Resident arrived at the Seville for a tour and met up with Staff 1 (S1) from Raya's Paradise. Three out of three witnesses state resident arrived unaccompanied to the Seville. Per physician report dated 02/04/2025, R1 is diagnosed with Dementia and unable to leave the facility unassisted. Based on record review and interviews conducted, the preponderance of evidence standard has been met, CONTINUED ON LIC 9099C DATED 07/01/2025 Substantiated therefore the following allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with facility representative and a copy of this report along with the Appeal Rights were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20250306122305

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 2, 2025

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 was provided care and supervision. R1 left the facility unattended to travel to another community. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: Licensee to read the regulation and forward a statement of understanding to LPA by POC due date.

Allegation investigated: Resident is being blocked from speaking with family via telephone

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to deliver findings on the above allegation. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as text messages. Regarding the allegation that resident is being blocked from speaking with family via telephone, the investigation revealed the following: Four out of six witnesses state Resident 1's (R1) phone had been removed by facility staff. Facility Administrator confirms removing the phone one time for a confirmation code to get electricity turned back on at the resident’s house. Upon review of R1’s admission agreement and facility program plan, the facility does not offer services to monitor/assist in resident home bills or monitoring of resident’s funds. LPA reviewed and obtained two text messages where Staff 1 and 2 had requested another staff to remove R1's phone from the resident per Facility Administrators on 01/08/2025 and 01/21/2025. During LPA Lyman’s initial visit on March 04, 2025, CONTINUED ON LIC 9099C DATED 07/01/2025 Substantiated LPA reviewed R1's phone and observed that a family member's phone number had been blocked. R1 denied blocking the number and did not know the process to block a number on the phone. While it remains unclear which staff member blocked the family member on the resident’s personal cell phone, the facility’s removal of R1’s personal cell phone out of their possession was determined to be unnecessary for the purposes of obtaining a code, as it could have been gathered while remaining in the possession of the resident. The removal of R1’s personal cell phone violated their personal rights to make and receive confidential calls and based on preponderance of evidence was blocked by one of the facility staff. Therefore the following allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with facility representative and a copy of this report along with the Appeal Rights were provided at the time of this visit. *This is an amended report. to allow alcohol due to resident's aggressive behavior when denied alcohol. Based on interviews conducted and record review, the department is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20250228162254

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(14) · Plan of correction due date: Jul 2, 2025

To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls. This requirement is not being met as evidenced by: Based on observation and interviews conducted, Licensee failed to ensure R1 had access to the resident's phone. Staff removed the resident's phone and LPA observed blocked family member's number on phone. This poses an immediate health and safety risk to resident's in care.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: Licensee to conduct an in-service on personal rights and forward proof to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman as well as Medi-Cal Bureau Agents Adam Provence and Neomia Tiscareno conducted an unannounced health and safety visit to the facility. LPA and agents were greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA and agents toured the facility and spoke with residents. Residents appeared clean and well taken care of. Residents verbalized satisfaction with facility care. No health or safety concerns noted during visit. LPA obtained resident roster and visitation log during the visit. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Raya's Paradise of San Clemente. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 80 bedridden residents. Facility has an approved hospice waiver for 40 residents and the facility currently has 4 residents on hospice care. Administrator Monica Westphaln has an administrator certificate valid until 11/08/2024. LPA Lyman along with Chief Operating Officer/ Executive Director Monica Wetsphaln and Maintenance Director Gilbert Buenrostro toured the facility at 11:45 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The facility consists of three stories housing an assisted living, memory care, gym, salon and multiple ouside patios. Resident apartments had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with a half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.0 and 110.10 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Delayed egress doors in memory care are operational. Facility has multiple first aid kits with all the elements including thermometer, tweezers and scissors. LPA observed no unsecured toxins during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility refrigerators and freezers are monitored and within temperature guidelines. LPA observed two dining rooms serving residents. Smoke detectors and Carbon Monoxide detectors are tested by an outside company with the last inspection conducted on 07/05/2024. Fire extinguishers are fully charged. LPA toured the outside grounds and there is ample shaded seating for residents in multiple patios. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 07/16/2024. CONT ON LIC809-C DATED 08/26/2024. Facility provides activities in the form of exercise, games, music and outings in the community. LPA reviewed select resident and staff files. Resident files contained required documents including admission agreements, physician reports, resident appraisals and orders for bed rails as indicated. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance. LPA reviewed medication storage and administration. Medications are stored in a locked medication cart. Medications are being administered per physician order. Based on the observations made during today's visit, NO citations are being issued. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 26, 2024