198204950-9-23-2026-11-AS-PMAA-DYSM2A-20261012091311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 09/23/2026
Date Signed: 09/23/2026 02:33:46 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
07/29/2026 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 11-AS-20260729083655

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:	DATE:	09/23/2026
		UNANNOUNCED	TIME BEGAN:	12:22 PM
MET WITH:	Ginger Enriquez		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff hit resident with an object
Staff did not safeguard resident's personal belongings
Staff are not providing adequate food service for resident
Staff inappropriately left resident in the elevator
Staff are not providing a safe environment for resident

INVESTIGATION FINDINGS:

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**On September 23, 2026, the Department conducted a subsequent visit to facility. The purpose of the visit is to clarify the findings in the report dated August 5, 2026. The findings will remain the same. On August 5, 2026, the Department of Social Services (DSS) staff conducted an initial unannounced complaint visit at the facility to investigate the above allegations and to deliver the findings. The department was greeted by Administrator Ginger Enriquez, and the purpose of the visit was explained.

The investigation consisted of the following:
On August 5, 2026, the Department obtained the following documents: Staff roster (dated 8/5/26), Resident roster (dated 6/4/26), Client/Resident Personal Property and Valuables form, Resident Appraisal (dated 3/7/26), Appraisal/ Needs and Services plan (dated 3/7/26), MAR (July 2026), Physician’s Report (dated 3/6/25), In-service training: Residents Rights (dated 1/23/26), Change of condition form (dated 6/26/26,12/10/25), Incident report (dated 7/22/26), Menu (August 2026).
On August 5, 2026, the Department interviewed Administrator (A1), 5 staff (S1-S5), 5 residents (R3-R5)
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260729083655

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: 09/23/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff hit resident with an object

The detail of the complaint alleges caregivers are "harsh," have hit R1 with pillows

On August 5, 2026, at 9:34am, the Department interviewed Administrator (A1) who stated that there have been no reports that caregivers are “harsh” with R1 nor have any report of them hitting R1 with a pillow.

On August 5, 2026, between 10:00am and 11:00am, the Department interviewed 5 staff members (S1-S5) regarding the allegation and of those interviewed, 5 out of 5 denied allegation stating that they have not handled R1 in a “harsh” manner nor have they witness any other staff handling R1 in a “harsh” manner.

On August 5, 2026, between 11:00 and 12:00 the Department interviewed 5 residents regarding the allegation and 4 out of 5 stated that staff have never handled them in a “harsh’ manner. 1 out of 5 residents stated that staff has handled them in a “harsh” manner but admitted that it was a “long time ago.”

On August 5, 2026, the Department reviewed and evaluated the following documents: Residents Rights (dated 1/23/26), Change of condition form (dated 6/26/26,12/10/25), Incident report (dated 7/22/26).

The change of condition notes and incident report listed above showed that 1 out of the 5 Residents interviewed had become confused saying things that weren’t there such as blaming staff for “eating banana’s from the resident’s banana tree."

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260729083655

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: 09/23/2026

NARRATIVE

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Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation: Staff did not safeguard resident's personal belongings

The detail of the complaint alleges that R1 personal belongings (purse, Bible, money) were taken

On August 5, 2026, at 9:34am, the Department interviewed Administrator (A1) who stated that there have been no reports of R1 missing any personal belonging. A1 further stated that R1 would claim that someone had stolen her belongings, but staff would find said items in R1’s room. Lastly, A1 stated that R1 has a locked chest in R1’s room where personal items are kept. R1 reportedly keeps the key to the locked box.

On August 5, 2026, between 10:00am and 11:00am, the Department interviewed 5 staff members (S1-S5) regarding the allegation and of those interviewed 5 out of 5 denied the allegation stating that there have been no items missing from R1’s room. 5 out of 5 stated that they have never taken anything from R1’s room nor have they witnessed any other staff taking anything from R1’s room.

On August 5, 2026, between 11:00am and 12:00pm, the Department interviewed 5 residents (R1-R5) regarding the allegation and 4 out of 5 stated that they have never had any personal items missing from their room. 1 out of 5 stated that they have had items missing from their room but admitted that it happened a long time ago “when the resident’s sister was alive.”

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260729083655

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: 09/23/2026

NARRATIVE

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On August 5, 2026, the Department reviewed the following documents: In-service training: Residents Rights (dated 1/23/26), Personal Property and Valuables form, and change of condition form (dated 6/26/26,12/10/25), which documented that 1 out of 5 resident interviewed showed signs of confusion

Allegation: Staff are not providing adequate food service for resident

The detail of the complaint alleges R1 was not given water or juice to take morning medication. It is also alleged that R1 missed breakfast on 7/29/26, and no water in the room, other than faucet water.

On August 5, 2026, at 9:34am, the Department interviewed Administrator (A1) who denied the allegation stating that water is always available to the residents. A1 further stated that medication is given during mealtimes, so water and juice are already at the table. In instances where MedTech’s have had to bring medicine to the resident’s room, the medtech always have a pitcher of water and cups. Lastly, A1 stated that medtech will bring water to the room upon request to the resident any time of the day and night. Lastly, food options are always given to the resident if they don’t want what is on menu. Residents have not missed meals.

On August 5, 2026, between 10:00am and 11:00am, the Department interviewed 5 staff members (S1-S5) regarding the allegation and of those interviewed 5 out of 5 stated that water is always assessable to the residents. 5 out of 5 state that staying hydrated is important so they would go and remind the residents to drink water and will have a water pitcher with them to make sure residents are getting water. Food is always offered to the residents even if they don’t want what is on the menu, we offer alternatives.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260729083655

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: 09/23/2026

NARRATIVE

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On August 5, 2026, between 11:00am and 12:00pm the Department interviewed 5 residents regarding the allegation and 5 out of 5 stated that they always have access to water. Lastly 5 out of 5 state that they are given food choices. 4 out of 5 report that they are always offered food choices. 1 out of 5 didn't remember if they had choices.

On August 5, 2026, the Department reviewed and evaluated the In-service training: Residents Rights (dated 1/23/26). Which showed that all staff have had Resident Right’s training.

Allegation: Staff inappropriately left resident in the elevator

The detail of the complaint alleges staff placed R1 in an elevator and left R1

On August 5, 2026, at 9:34am, the Department interviewed Administrator (A1) who denied the allegation stating that there have been no reports of R1 being left unsupervised in an elevator. A1 further stated that R1 is always supervised and is never left alone outside the R1’s room

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 7

Control Number 11-AS-20260729083655

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: 09/23/2026

NARRATIVE

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On August 5, 2026, between 11:00am and 12:00pm, the Department interviewed 5 residents (R1-R5) regarding the allegation and of those interviewed 4 out of 5 state they have not seen a resident who required assistance left alone in the elevator. 1 out of 5 state that they had been left alone in an elevator but admitted it had been “years” ago.

On August 5, 2026, the Department reviewed and evaluated the following documents: In-service training: Residents Rights (dated 1/23/26). Which showed that all staff have had Resident Rights training.

Allegation: Staff are not providing a safe environment for resident

The detail of the complaint alleges that R1 does not feel safe in R1’s environment, as R1 repeated requests for help and not being left alone.

On August 5, 2026, at 9:34am, the Department interviewed Administrator (A1) who denied the allegation stating that there have been no reports of R1 feeling unsafe in the facility.

On August 5, 2026, between 10:00am and 11:00am, the Department interviewed 5 staff members (S1-S5) regarding the allegation and of those interviewed 5 out of 5 stated that R1 has never expressed feeling unsafe in the facility, nor have R1 expressed that R1 didn’t want to be left alone.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 11-AS-20260729083655

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: 09/23/2026

NARRATIVE

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On August 5, 2026, between 11:00am and 12:00pm the Department interviewed 5 residents regarding the allegation and 5 out of 5 stated that they feel safe and cared for at the facility.

On August 5, 2026, the Department reviewed the following documents: In-service training: Residents Rights (dated 1/23/26). Which showed that all staff have had Resident Rights training.

Exit interview conducted with Ginger Enriquez Administrator. There were no deficiencies cited during today’s visit. Copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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