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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320558
Report Date: 06/12/2025
Date Signed: 06/12/2025 12:21:16 PM

Document Has Been Signed on 06/12/2025 12:21 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 COMMUNITY 11FACILITY NUMBER:
198320558
ADMINISTRATOR/
DIRECTOR:		BENEDICTO, ABIGAIL MIKAFACILITY TYPE:
740
ADDRESS:2874 FIDLER AVETELEPHONE:
(562) 452-7041
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 6CENSUS: 5DATE:
06/12/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Alberto Pimentel NarezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On June 12, 2025 Licensing Program Analysts (LPA) Deborah Lee conducted a pre-licensing Change of ownership (CHOW) evaluation for an RCFE facility type. Today’s pre-licensing evaluation was conducted with Albert Pimentel Narez.

The licensee has applied for a license to serve ( 6 ) elderly residents ages 60 and over. The fire clearance is approved for ( 5 ) non-ambulatory and ( 1 ) bedridden on bedroom #4.

A tour of the Kitchen, Dining Room, Living Room, (6) Bedrooms, (2) Bathrooms, Back Yard, and Patio with shade.

The following was observed during this visit:

Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: ( 6) residents' rooms, ( 2 ) bathrooms, a living area, a dining area, a kitchen, an outside seating area and an attached garage. Facility is clean, sanitary, and in good repair.

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NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Deborah Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2025
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: STERLING SENIOR COMMUNITY 11
FACILITY NUMBER: 198320558
VISIT DATE: 06/12/2025
NARRATIVE
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Indoor and outdoor passageways, stairways, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair, and areas of potential hazard are well-lit and equipped with sturdy hand railings. Smoke alarms operate properly. Carbon monoxide detectors operate properly.

PHYSICAL PLANT

LPA and Alberto Pimentel Narez toured the facility inside and outside. LPA observed there were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. LPA observed that facility had required postings: ombudsman poster, see something say something poster, emergency numbers, clients rights, employee Federal/State wage information, facility sketch,

BEDROOMS

LPA inspected all six (6) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, night stands, chairs, and ample storage space for personal belongings. No resident bedroom is a passageway to another room, bath or toilet.

BATHROOMS

LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The water temperature measured 109.4 -degrees Fahrenheit.

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NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Deborah Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
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 COMMUNITY 11
FACILITY NUMBER: 198320558
VISIT DATE: 06/12/2025
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FOOD SERVICE

Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked drawers in the kitchen and are inaccessible to residents. LPA observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods. Cleaning products and toxins were secured in hall closet that is inaccessible to clients.

MEDICATIONS

There is a locked centralized storage area for Resident medications.

RECORDS

There is confidential storage of personnel records at the facility. There is confidential storage of resident records at the facility. LPA reviewed (3 ) staff files and found (3) out of ( 3) contained the required documentation, certification, and training. Liability Insurance expires on 11/14/25. LPA reviewed (3) resident files and found (3 ) out of (3 ) contained all the necessary documentation: Admission Agreement, Medical Assessments, Consent forms, ID, TB tests, Personal Rights, and Appraisal/Needs and Services plan.

There are no corrections needed.

Component III: Conducted during today’s Pre-Licensing visit. A copy of report provided was provided to Administrator.

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NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Deborah Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC809 (FAS) - (06/04)
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