BUN CIRCLE SENIOR CARE HOME

21504 GRACE AVE, Carson CA 90745

Facility 198320363 · RESIDENTIAL CARE ELDERLY (740)

6 bedsLatest official report Sep 26, 2025Licensed

Additional info
Licensee
BUN CIRCLE SENIOR CARE LLC
Administrator
ABEYSINGHE, NILUSHA
Contact
ABEYSINGHE, NILUSHA
License first date
Sep 20, 2023
License effective date
Sep 20, 2023
District office
EL SEGUNDO ASC · (424) 544-1075
Regional office
11
Clients served
983 - RCFE / DEMENTIA, 985 - RCFE / HOSPICE

Summary

The available records show 6 Type B deficiencies for this facility.

Most recent inspection
Sep 26, 2025
Most recent deficiency
Sep 26, 2025

No later report is available, so the records do not show what happened afterward.

What Type A and Type B mean
Type A
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
Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.

Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.

At a glance

Counts cover the five-year public record. Typical figures are the median for the 1,564 Los Angeles County facilities licensed for 6 or fewer beds.

In the available public five-year record, CCLD published 5 reports for this facility: 3 inspections, 0 complaint investigations, and 2 licensing or administrative records.

Those records contain 0 Type A and 6 Type B deficiencies.

0 deficiencies have explicit official correction or clearance evidence in the loaded records.

Official inspections
3

Fewer than the typical 4

1 in the last 12 months

Recorded deficiencies
6

Well above the typical 1

2 in the last 12 months

Type A deficiencies
0

Most this size also have none

0 in the last 12 months

Type B deficiencies
6

Most this size have none

2 in the last 12 months

Substantiated complaints
0

Most this size also have none

0 in the last 12 months

Repeated topics
0

Last 36 months

Repeated topics

Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.

No topic repeats in the last 36 months

No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.

Official report history

All preserved reports from the most recent to the oldest, sortable by report type.

Inspection
Health conditions and treatmentsType B
Official classification
Type B
Official code
87608(3)
Regulation authority
CCR

What the official deficiency says

87608 Postural Supports (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 This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and review the licensee did not comply with the section cited above. LPA identified Resident #2 had full bed rails and did not have physician’s orders on file. Resident was not on hospice. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/03/2025 Plan of Correction Licensee will ensure to review and adhere to Title 22 87608 Regulations. LIcensee will remove full bed rails for Resident #2 or submit a physician's orders authorization for full bedrails. Proof of correction must be submitted to ernand.dabuet@dss.ca.gov by 10/03/25.

Plan of correction recorded
Correction not verified in available records
View official report
Incident reportingType B
Official classification
Type B
Official code
87211(a)(1)(D)
Regulation authority
CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency...of the occurrence of any of the events... (D) Any incident which threatens the welfare, safety or health of any... This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's interviews conducted and record reviews, the Licensee failed to report incident R1 & R3 admittance for hospitalizations and plumbing repairs for the facilty. This violation poses a potential health and safety risk to all residents in care.

Official plan of correction

POC Due Date: 10/03/2025 Plan of Correction Licensee agrees that a Plan of Correction will be submitted to CCLD by 10/03/25 with Unusual Incident Reports LIC 624 involving (R1 & R3) hospitalization incidents and plumbing repairs to (CCL). POC must be fax to 424-544-1016 by 10/03/25.

Plan of correction recorded
Correction not verified in available records
View official report
Inspection
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
87412(a)(11)
Regulation authority
CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. LPA identified Staff #1-#6 did not have LIC 503 Health Screening and Staff #4, #5, #6 did not have TB Test Results on file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction Licensee will adhere to Title 22 87412 and ensure that each staff have Health Screening LIC 503 on file along with TB Test Results. Proof of correction of a completed fire drill will be sent as proof to ernand.dabuet@dss.ca.gov by POC due date 10/10/24.

Plan of correction recorded
Correction not verified in available records
View official report
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
1569.625(b)(2)
Regulation authority
HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. LPA identified staff #1-#6 had no traiing records completed on file. This vioation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2024 Plan of Correction Licensee will adhere to Health & Safety 1569.625 and ensure all staff that have direct care to residents must have completed medical training including dementia, postural support, and restricted health. Proof of correction of a completed fire drill will be sent as proof to ernand.dabuet@dss.ca.gov by POC due date 10/10/24.

Plan of correction recorded
Correction not verified in available records
View official report
Fire safety and emergency preparednessType B
Official classification
Type B
Official code
1569.69(a)(2)
Regulation authority
HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. LPA identified staff #1-#6 all did not have medication training completed on file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction Licensee will adhere to Health & Safety 1569.69 and ensure all caregiver staff have completed medication training. Proof of correction of a completed certificates for staff #1-#6 will be sent as proof to ernand.dabuet@dss.ca.gov by POC due date 09/11/24.

Plan of correction recorded
Correction not verified in available records
View official report
Fire safety and emergency preparednessType B
Official classification
Type B
Official code
1569.695(c)
Regulation authority
HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. LPA identified the facility had no record of emergency/fire dril conducted within the quarterly period. This violaton which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction Licensee will adhere to Health & Safety 1569.695 and ensure quarterly emergency fire drills are conducted with residents and staff. Proof of correction of a completed fire drill will be sent as proof to ernand.dabuet@dss.ca.gov by POC due date 10/10/24.

Plan of correction recorded
Correction not verified in available records
View official report
Licensing recordNot an inspection of the operating facility
No deficiencies recorded in this report
Licensing recordNot an inspection of the operating facility
No deficiencies recorded in this report

Source and limits

California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.

Read the data methodology