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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 06/30/2026
Date Signed: 06/30/2026 10:46:29 AM

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
05/04/2026 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260504140021
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:
06/30/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ginger EnriquezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are not properly addressing bed bug infestation in the facility.
INVESTIGATION FINDINGS:
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This report supersedes the report created on 05/13/2026 to include additional observations conducted during today’s subsequent complaint investigation visit. The findings remain unchanged.
The investigation consisted of the following: On 05/13/2026 The Department interviewed ten (10) staff members (S1-S10) and eleven (11) residents (R1-R11), conducted observations of the facility, including the television room, common areas, memory care unit, and assisted living area, and reviewed pest control receipts, staff and resident rosters, a resident file, the facility food policy, and the food menu for May 2026.
On 06/30/2026, the Department returned to the facility and conducted additional observations related to the allegation. Along with Assistant Administrator and staff, six (6) residents’ bedrooms, including beds, mattresses, mattresses, seams, bedframes, furniture seams, and linens, were inspected for visible signs of bed bug activity. The Department also inspected the television room across from the receptionist office and hallway areas.
Please see report continuation on (LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
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 2
Control Number 11-AS-20260504140021
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: 06/30/2026
NARRATIVE
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The investigation revealed the following: Regarding the allegation that staff are not properly addressing a bed bug infestation in the facility: Interviews revealed the following: interviews conducted with ten (10) staff members (S1-S10) denied knowledge of an active bed bug infestation within the facility. Resident interviews conducted with eleven (11) residents (R1-R11) did not corroborate the presence of bed bugs. LPA’s observations revealed the following: On 05/13/2026, LPA did not observe bed bugs within the television room or common areas. On 06/30/2026 LPA did not observe live bed bugs or visible signs of bed bug activity, including insects consistent with bed bugs, fecal spotting, blood spots, shed skins, eggs, or other visible evidence. Records reviewed revealed the following: pest control invoices and treatment records documenting ongoing extermination services conducted on multiple dates, including March 18, March 25, April 1, April 8, April 15, and May 6, 2026. Records documented treatment and monitoring for various pests, including bed bugs, and indicated continued pest control maintenance services were being provided. Based on the evidence gathered, interviews conducted, observations made, and records reviewed, although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated.

No deficiencies were cited regarding this allegation. An exit interview was conducted, and a copy of this report was provided to the Assistant Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
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