198602239-7-27-2026-11-AS-EGOZ-DWE2VP-20260727174416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602239
Report Date: 07/27/2026
Date Signed: 07/27/2026 05:44:28 PM

Document Has Been Signed on 07/27/2026 05:44 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:	STERLING SENIOR LIVING		FACILITY NUMBER:	198602239
ADMINISTRATOR/ DIRECTOR:	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:	07/27/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:05 PM
MET WITH:	Ricardo Bernal		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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On 07/27/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced required annual inspection. The department met with House Manager Ricardo Bernal and explained the purpose of the visit. The department was granted entry to the facility.

The facility is licensed for six (6) residents age range 60 and over. Of those residents, two (2) may be ambulatory, four (4) may non-ambulatory, of which two (2) may be bedridden. The facility has an approved hospice waiver for two (2) residents.

The facility is a single story structure located in a residential neighborhood. This facility consists of the following: five (5) resident bedrooms, one staff bedroom, two (2) bathrooms, an office area, foyer, kitchen, living room, dining area, a wheelchair ramp (located on the right side of the house), backyard patio, and a garage, with a laundry area.

The department conducted a tour of the physical plant. There are no bodies of water on the premises. All resident bedrooms were checked. Beds and bedding were in good condition. Adequate lighting is observed, and storage for resident’s personal belonging was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperature properly measured between 105.0 F and 120.0 F.

Continued on LIC809-C

Stephanie Cifuentes
Elvira Gonzalez
	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

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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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: STERLING SENIOR LIVING	FACILITY NUMBER: 198602239
	VISIT DATE: 07/27/2026

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A comfortable temperature is maintained in the facility. The department observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there was enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged; smoke detectors and carbon monoxide were operable. First Aid kit along with manual was available. Common areas were clean and clear of hazards; doorways were free of obstructions.

The department conducted a records review of six (6) resident service records, and four (4) staff records. All resident and staff records were complete and in order. The department reviewed, three (3) Medication Administration Records and observed discrepancies at the time of visit. Citation will follow.

The facility has an administrator certificate for Sheryl Tongol #7021416740 Exp. 12/19/27. The facility has an active Liability Insurance through Kyber Associates Insurance Brokerage LLC, #00136973-3 valid 11/04/25 -11/04/26. The facility fees are current..

Deficiencies are being cited based on observation and record review in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted, and a copy of this report and appeals was discussed and left with House Manager Ricardo Bernal.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Elvira Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

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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Document Has Been Signed on 07/27/2026 05:44 PM - It Cannot Be Edited

Created By: Elvira Gonzalez On 07/27/2026 at 04:14 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: STERLING SENIOR LIVING	FACILITY NUMBER: 198602239
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(a)(4)

87465 Incidental Medical and Dental Care (a) A plan for incidental medical/ dental care shall be developed by each facility. The plan shall encourage routine medical/dental care & provide for assistance in obtaining such care. (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, records reviewed, and interviews conducted, records revealed that one (1) medication for R6 had an entry on the MAR as administered but medication was not dispensed and still in the bubble pack. This action poses a potential health and safety risk to persons in care.
	POC Due Date: 08/10/2026
	Plan of Correction
1 2 3 4	The licensee will have all staff who administer medication to the residents retrained on medication administration procedures and medication documentation. Licensee will submit copies of in-service sign in sheet as well as training materials reviewed by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

LIC809 (FAS) - (06/04)

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