198204950-10-21-2025-11-AS-JHAD-DMS2JB-20251024172604

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 10/21/2025
Date Signed: 10/21/2025 08:11:33 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
10/02/2025 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251002090122

FACILITY NAME:	CARSON SENIOR ASSISTED LIVING		FACILITY NUMBER:	198204950
ADMINISTRATOR:	SHOLOM GOLDMAN		FACILITY TYPE:	740
ADDRESS:	345 EAST CARSON STREET		TELEPHONE:	(310) 830-4010
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	230	CENSUS: 167	DATE:	10/21/2025
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Ginger Enriquez		TIME COMPLETED:	04:27 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in a timely manner.

INVESTIGATION FINDINGS:

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On October 21, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit at this facility. Ginger Enriquez the administrator greeted LPA. LPA explained that the purpose of this visit was to gather information for the allegation mentioned above.

The investigation consisted of the following: An interview with Resident #1 to #10 (R1-R10) and Staff #1 to Staff #4 (S1-S4). A copy of the Facitliy Roster (dated 10/21/25), Register of Facilty Resident LIC 9020, Personnel Report LIC 500, (dated 10/03/25), Resident Face Sheet (dated 10/03/23), Identification and Emergency Information Lic 601 (dated 10/10/23), Admissions Agreement (dated 10/03/23), and Consent for Emergency Medical Treatment LIC 627C (dated10/10/10/23), Physician’s Report LIC 624 (dated 03/27/25), Preplacement Appraisal Information LIC 603 (dated 08/26/23), and Medication Administration Record (dated 10/01/25 to 10/31/25) and other pertinent records associated with this complaint.
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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 3

Control Number 11-AS-20251002090122

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: 10/21/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not seek medical attention for resident in a timely manner.

The complaint alleges that facility staff failed to promptly seek medical attention for Resident #1 (R1). Reports indicated that (R1) was very sick, yet the staff did not take any action to treat the illness. (R1) is experiencing cold symptoms and, although other residents are also ill, suspects it may be COVID-19, which raises concerns given (R1's) other underlying health issues. No additional information regarding this situation was provided.

On October 03, 2025, and October 21, 2025, between 09:50 AM and 03:45 PM, the Department interviewed staff members identified as Staff #1 through Staff #4. Four (4) out of the four (4) staff members could not support the allegation. Each of them confirmed that no COVID-19 cases had been reported among the facility's residents or staff. Staff members (S1-S4) stated that the facility continues to take proactive measures to stay up to date on COVID-19 vaccinations, practice good hygiene, wear masks, maintain distance from individuals who are ill, and isolate those individuals when necessary. According to the information from (S1-S4), (R1) is independent and capable of self-care with no requirement of assistance with activities of daily living, leave the facility every day, and do not have any mental health conditions. (R1) only requires assistance with daily medication administration. (S1-S4) confirmed that (R1) exhibited no symptoms of cold or flu, and no symptoms were ever observed that would require immediate medical attention. (S1-S3) reported the residents are actively monitored for cold or flu symptoms. When symptoms are observed, primary physicians are promptly notified. Should these symptoms persist for multiple days, hospitalization may be necessary, as recommended by the physician.

On October 03, 2025, and October 21, 2025, between 9:35 AM and 03:45 PM, the Department interviewed resident members identified Resident #1 through Resident #10 (R1-R10). Nine (9) out of the ten (10) resident members could not corroborate this allegation. Eight (8) out of the ten (10) confirmed that they receive adequate medical attention and that staff are responsive to their medical needs. (R2), who shares a room with (R1), denied claims that (R1) is ill or showing symptoms of a cold or flu. (R2) stated that (R2) would generally be aware of (R1)'s health condition, given our close living quarters, and that (R2) would report to staff immediately if either of them was ill.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251002090122

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: 10/21/2025

NARRATIVE

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(R1) mentioned that (R1) experienced a minor cough a few weeks ago, which did not require medical treatment. Although it persisted for several days, (R1) did not have any COVID-19-related symptoms. (R1) stated that (R1) continues to receive daily assistance with medication administration from the staff and is satisfied with the care services provided. (R1) stated to be independent and have no mental condition and can freely advocate for self.

The Department reviewed (R1’s) Resident Face Sheet (dated 10/03/23), Identification and Emergency Information LIC 601 (dated 10/10/23), Admissions Agreement (dated 10/03/23), and Consent for Emergency Medical Treatment LIC 627C (dated 10/10/10/23). Further review of the Physician’s Report LIC 624 (dated 03/27/25), Preplacement Appraisal Information LIC 603 (dated 08/26/23), and Medication Administration Record (dated 10/01/25 to 10/31/25) verified (R1) is capable of self-care with no mental health conditions and requires only assistance with medication.

During visits on October 3, 2025, and October 21, 2025, the Department did not observe any residents or staff displaying symptoms of illness. The Department observed the facility's infection control practices with screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. The Department observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated infection control posters were posted. Additionally, the facility had not reported any COVID-related cases to Community Care Licensing.

Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

No deficiencies issued.

An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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