198320433-8-11-2026-11-AS-EGOZ-DWUV8N-20260811161301

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320433
Report Date: 08/11/2026
Date Signed: 08/11/2026 04:13:17 PM

Document Has Been Signed on 08/11/2026 04:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	OCEANVIEW LIVING OF SAN PEDRO		FACILITY NUMBER:	198320433
ADMINISTRATOR/ DIRECTOR:	MARIA GALVAN		FACILITY TYPE:	740
ADDRESS:	2100 SOUTH WESTERN AVENUE		TELEPHONE:	(310) 548-0625
CITY:	SAN PEDRO	STATE: CA	ZIP CODE:	90732
CAPACITY: 86		CENSUS: 76	DATE:	08/11/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:18 AM
MET WITH:	Anita Csukardi		TIME VISIT/ INSPECTION COMPLETED:	04:35 PM

NARRATIVE

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On 08/11/26, the department conducted an unannounced annual required visit using the CARE Inspection Tool. The department met with Anita Csukardi, Executive Director, and the purpose of the visit was explained. The department was granted entry to the facility. The facility is licensed to serve (86) non-ambulatory elderly adults ages 60 and over, of which (9) maybe bedridden. The facility is approved for (12) hospice residents.

The facility is a (3) floor building and consists of (96) bedrooms, (75) bathrooms, commercial kitchen, large dining room, auditorium, storage areas, nursing stations, activity rooms, exercise room, recreation room, medical supply room, craft room, conference rooms, shaded patio areas, side courtyard, and laundry rooms.

The department toured the physical plant. There were no bodies of water or obstructions on the premises. Several rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be operational and within Title 22 regulations. The department inspected rooms: #101, #103, #110, #126, #205, #212, and #225. The water temperature properly measured between 105.0 - 120.0 degrees F. A comfortable temperature was observed throughout the facility. Call buttons, and smoke and carbon monoxide are all in operating condition.

The department observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there was sufficient perishable and non-perishable food available maintained properly.

Continued on LIC809-C

Stephanie Cifuentes
Elvira Gonzalez
	DATE: 08/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

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

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

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

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

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

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

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

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

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

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: OCEANVIEW LIVING OF SAN PEDRO	FACILITY NUMBER: 198320433
	VISIT DATE: 08/11/2026

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The last emergency and fire drills were completed on 07/31/26. All fire extinguishers were charged. Several working landline phones are available on-site. First aid kit, along with manual was available. A review of Medication Administration Records found to be in order and accurate.

The department conducted a review of service records for residents #1-#6 (R1-R6) and personnel records for staff #1-#5 (S1-S5) and found them to be complete and in order. Community Care Licensing annual fees are current. The facility has a current Administrator's Certificate for Anita Csukardi, certificate #7005419740, effective: 07/30/26, and expires: 07/29/28. The facility has a current liability insurance policy with Shomer Insurance Services an Alera Group, policy #H0076PK00613-01, effective: 05/01/26 through 05/01/27.

During the visit, the department observed the facility's infection control practices. The department observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters, including the Activities Calendar and Food Menu, were posted.

Deficiencies are being cited according to California Code of Regulation, see LIC809-D.

An exit interview was conducted, and a copy of this report was provided to Anita Csukardi.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Elvira Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/11/2026 04:13 PM - It Cannot Be Edited

Created By: Elvira Gonzalez On 08/11/2026 at 02:51 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO	FACILITY NUMBER: 198320433
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87411(c)(1)

87411 Personnel Requirements - General, (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. Staff #1 and #2, did not have a valid First Aid/CPR certificate on file. This violation poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2026
	Plan of Correction
1 2 3 4	Licensee will ensure all staff who have direct care with residents must have completed First Aid/CPR training. Proof of correction must be sent to LPA Elvira.Gonzalez@dss.ca.gov

Type B

Section Cited

CCR

87411(f)

87411(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. The department identified staff #1 did not have a TB test on file, and staff #2 did not have TB test or Health Screening on file. This violation poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2026
	Plan of Correction
1 2 3 4	Licensee will ensure that all staff have Health Screening and TB tests on file. Proof of correction must be sent to LPA Elvira.Gonzalez@dss.ca.gov

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephanie Cifuentes
NAME OF LICENSING PROGRAM MANAGER:

	Elvira Gonzalez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

LIC809 (FAS) - (06/04)

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