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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 07/09/2026
Date Signed: 07/09/2026 03:49:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2026 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20260630121105
FACILITY NAME:CARSON SENIOR ASSISTED LIVINGFACILITY NUMBER:
198204950
ADMINISTRATOR:SHOLOM GOLDMANFACILITY TYPE:
740
ADDRESS:345 EAST CARSON STREETTELEPHONE:
(310) 830-4010
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:230CENSUS: 166DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Ginger EnriquezTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff stole money from resident in care
Staff do not ensure hazardous items are inaccessible to residents.
Staff do not ensure the facility is free of insects.
Staff do not provide activities.
Staff do not adequately supervise residents.
INVESTIGATION FINDINGS:
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On 07/09/26 at 2:30 pm Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Administrator Ginger Enriquez (staff #1/S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 07/08/26 LPA Villegas obtained copies of the staff and resident roster, activity calendar for June 2026-July 2026, pest control reports for April 2026-June 2026, and copies of the following documents for Resident #1 (R1) Emergency ID form, pre-appraisal dated: 05/13/25, Physicians report dated: 04/22/26, needs and service plan dated: 05/16/26, resident appraisal dated: 05/16/26, property sheet dated: 05/13/26 medication administration record (MARs) from June 2026-July 2026, and copies of incident reports dated: 04/10/26, 04/13/26, and 04/30/26. On 07/08/26 from 9:30 am- 11:45 am LPA conducted Interviews Residents # 1-10 (R1-R10), and on 07/08/26 and 07/09/26 LPA conducted interviews with staff #1-7 (S1-S7). On 07/08/26 and 07/09/26 LPA conducted a check of (4) bedrooms on both floors.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 11-AS-20260630121105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CARSON SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204950
VISIT DATE: 07/09/2026
NARRATIVE
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The allegation revealed the following:

Allegation: Staff stole money from a resident in care.

It Is alleged that facility staff stole money from a resident in care. On 07/08/26 from 9:30 am- 11:45 am LPA conducted Interviews R1-R10 regarding the allegation above. 9 of the 10 residents interviewed denied the above allegation. 1 of the 10 residents interviewed confirmed the allegation above and stated that they believe a facility staff is taking money from their social security check. On 07/08/26 and 07/09/26 LPA conducted interviews with S1-S7 regarding the allegation above. 7 of the 7 staff interviewed denied the allegation above. Furthermore, 6 of the 7 staff stated that if a resident reports missing money, staff would report to management. 1 of the 7 staff interviewed stated that the facility would investigate the concern, search the resident's room and belongings when appropriate, contact family members if applicable, documents findings, and files required reports. 07/08/26 LPA conducted a review of R1’s Physicians report dated: 04/22/26 and resident appraisal dated: 05/16/26. Upon review LPA observed that R1 cannot handle cash resources and has a DPOA who handles finances, facility does not have access to resident’s cash resources.

Allegation: Staff do not ensure hazardous items are inaccessible to residents.

It is alleged that a resident in care consumed a chemical left behind by staff. On 07/08/26 from 9:30 am- 11:45 am LPA conducted Interviews R1-R10 regarding the allegation above. 9 of the 10 residents interviewed denied the above allegation. 1 of the 10 residents interviewed confirmed the allegation above and reported they consumed pine sol thinking it was mouthwash. On 07/08/26 and 07/09/26 LPA conducted interviews with S1-S7 regarding the allegation above. 6 of the 7 staff interviewed denied the allegation above, 1 of the 7 staff interviewed reported having no knowledge of the allegation above. 4 of the 7 staff interviewed indicated that chemicals and toxins are locked in a storage room, 3 of the 7 staff interviewed stated they are unaware of where chemicals and toxins are stored. On 07/09/26 LPA toured facility with S6, LPA observed 5 locked storage rooms located on the 2nd floor.

Allegation: Staff do not ensure the facility is free of insects.

It is alleged that a resident’s bedroom is full of roaches. On 07/08/26 from 9:30 am- 11:45 am LPA conducted Interviews R1-R10 regarding the allegation above. 1 of the 10 residents interviewed denied the above allegation. 4 of the 10 residents interviewed confirmed the allegation above and reported notifying it to staff, and the bedroom was treated. 5 of the 10 residents interviewed reported seeing

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20260630121105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CARSON SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204950
VISIT DATE: 07/09/2026
NARRATIVE
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roaches in the past. 10 of 10 residents interviewed confirmed that pest control comes out regularly to service the facility. On 07/08/26 and 07/09/26 LPA conducted interviews with S1-S7 regarding the allegation above. 2 of the 7 staff interviewed reported having no knowledge of the above allegation. 5 of the 7 staff interviewed denied the allegation above, 2 of the 5 staff stated that residents have reported roaches in their bedroom in the past but nothing recent. 7 of 7 staff interviewed reported that the facility has pest control services come out regularly. On 07/08/26 LPA conducted a review of pest control reports dated :04/15/26, 05/06/26, and 06/10/26. Per maintenance service reports no pest activity was found. On 07/08/26 and 07/09/26 LPA conducted a check of (4) bedrooms on both floors, LPA did not observe any pest.

Allegation: Staff do not provide activities.

It is alleged that facility does not provide activities for the residents in care. On 07/08/26 from 9:30 am- 11:45 am LPA conducted Interviews R1-R10 regarding the allegation above. 9 of the 10 residents interviewed denied the above allegation, although residents reported that for the most part residents do not want to participate in activities. 1 of the 10 residents interviewed confirmed the allegation above and reported no activities are provided by facility staff. On 07/08/26 and 07/09/26 LPA conducted interviews with S1-S7 regarding the allegation above. 7 of the 7 staff interviewed denied the allegation above and reported activities are provided daily. 6 of the 7 staff reported that residents are reminded and encouraged to participate in activities being held. 1 of the 7 staff stated they are unaware of what staff are doing to engage residents in activities. On 07/08/26 LPA conducted a review of activity calendar for June 2026-July 2026. LPA observed that 3-4 activities are scheduled throughout each day. During visit LPA observed residents being notified and encouraged to participate in activities, LPA observed residents to opt out of activities and made their way outdoors.

Allegation: Staff do not adequately supervise residents.

It is alleged that facility staff are not checking on residents when residents are right outside of the facility. On 07/08/26 from 9:30 am- 11:45 am LPA conducted Interviews R1-R10 regarding the allegation above. 4 of the 10 residents interviewed could not provide information regarding the

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 11-AS-20260630121105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CARSON SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204950
VISIT DATE: 07/09/2026
NARRATIVE
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allegation as they do not leave the facility. 1 of the 10 residents denied the allegation above and reported staff checking in with residents if staff have something urgent for them. 5 of the 10 residents interviewed confirmed the above allegation and report that staff do not check in on them when they are out in the community. Additionally, 6 of 7 residents stated that residents must sign in and out of the facility when going out to the community. On 07/08/26 and 07/09/26 LPA conducted interviews with S1-S7 regarding the allegation above. 3 of the 7 staff interviewed reported having no knowledge of the above allegation. 2 of the 7 staff interviewed confirmed the allegation above and reported that if staff are sitting outside the facility, staff will check in with residents in addition to the cameras outside. 2 of the 7 staff interviewed reported that staff will monitor the sign in/out log to monitor return times. Additionally, 6 of 7 staff interviewed reported that residents have been educated in community safety. On 07/08/26 LPA observed residents coming in and out of the facility throughout the day, LPA observed most residents to stop at the front office to either sign in or sign back out.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4