198602239-6-17-2026-11-AS-PMAA-DVHPZQ-20260629114553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602239
Report Date: 06/17/2026
Date Signed: 06/17/2026 03:47:50 PM

Substantiated

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
04/27/2026 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260427084652

FACILITY NAME:	STERLING SENIOR LIVING		FACILITY NUMBER:	198602239
ADMINISTRATOR:	KELLOGG, MICHELLE		FACILITY TYPE:	740
ADDRESS:	2210 W 234TH STREET		TELEPHONE:	(310) 325-2275
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 6	DATE:	06/17/2026
		UNANNOUNCED	TIME BEGAN:	01:48 PM
MET WITH:	Ricky Bernal		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are inappropriately restraining a resident resulting in injuries.

INVESTIGATION FINDINGS:

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On 06/17/26, the department conducted an unannounced subsequent complaint visit to deliver an amended report. *This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 05/06/26.*

On 05/06/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the above mentioned allegation. LPA met with House Manager, Ricky Bernal, and the purpose of the visit was explained. LPA was granted entry to the facility.

The investigation consisted of the following: On 05/06/26, the department received the following documents: staff roster, resident roster, and In-Service Training Guide for caregivers (dated: 04/22/26).

CONTINUED ON LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

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-20260427084652

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: STERLING SENIOR LIVING	FACILITY NUMBER: 198602239
	VISIT DATE: 06/17/2026

NARRATIVE

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The department reviewed resident #1’s (R1) service file and received the following documents: Admission Agreement (dated: 03/06/26), Physician’s Report (LIC 602), Preplacement Appraisal Information, Needs & Services Plan (dated: 03/09/26), and Physician order (dated: 04/06/26). Additionally, the department conducted interviews with staff #1-#3 (S1-S3), witnesses #1-#2 (W1-W2), residents #1 (R1), #5-#6 (R5-R6), and attempted to interview residents #2-#4 (R2-R4). Furthermore, the department conducted a tour of the facility.

The investigation revealed the following:

Allegation: Staff are inappropriately restraining a resident resulting in injuries. It is being alleged that a resident sustained bruising to their wrists and ankles due to facility staff restraining them. Record review of R1’s Admission Agreement dated 03/06/26 confirms that R1 was admitted to the facility on 03/06/26. Review of the Physician’s Report dated 03/06/26 indicates that R1 is ambulatory. The department reviewed R1’s Appraisal/Needs and Services Plan dated 03/09/26 and did not observe any documented need for postural supports or restraining devices. Record review of a physician’s order dated 04/06/26 reflects an order authorizing full side rails and a self-releasing seat belt for R1.

On 05/06/26, the department conducted a tour of the facility and observed all residents present. During the tour, no bruising was observed on any resident’s wrists, and/or ankles.

On 05/06/26, the department conducted interviews with S1–S3. Of those interviewed, 3 out of 3 staff denied the allegation and stated they do not restrain residents without a physician’s order. However, during the interview, S1 disclosed that a wheelchair seat belt had been placed on R1 without a physician’s order from the time of admission until approximately one month ago. S1 stated the seat belt was used depending on R1’s behavior and sundowning episodes and was discontinued once staff were informed that no physician’s order existed. An interview with S2 revealed that a self-releasing seat belt is used on R1 at times, depending on behavior. S2 stated there is a physician’s order authorizing a self-releasing seat belt and full side rails for R1.

CONTINUED ON LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260427084652

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: STERLING SENIOR LIVING	FACILITY NUMBER: 198602239
	VISIT DATE: 06/17/2026

NARRATIVE

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On 05/06/26, the department conducted interviews with R1 and R5–R6 and attempted to interview R2–R4 but was unable to due to cognitive impairment. Of those interviewed, 3 out of 3 residents could not corroborate the allegation.

On 05/06/26, the department conducted interviews with W1-W2. Attempts were made to contact W3-W4 for interviews; however, they did not respond. Of those interviewed, 1 out of 2 witnesses corroborated the allegation.

Based on record reviews, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter 8), are being cited on the attached LIC 9099D.

An exit interview was conducted with Ricky Bernal, and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260427084652

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: STERLING SENIOR LIVING	FACILITY NUMBER: 198602239
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/24/2026 Section Cited CCR 87608(a)(3)	1 2 3 4 5 6 7	87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee agreed to conduct an in service training for all staff on section cited and residents personal rights. The licensee shall submit to the department a copy of the sign in sheet, and training materials, by the POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted and records reviewed, S1 acknowledged that a seatbelt was placed on R1 since being admitted. The licensee did not have a physician’s order for Postural Supports until 04/06/26. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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