SOUTH BAY RESIDENTIAL HOME

430 WEST 214TH STREET, Carson CA 90745

Facility 198205247 · RESIDENTIAL CARE ELDERLY (740)

6 bedsLatest official report Mar 23, 2026Licensed

Additional info
Licensee
SOUTH BAY GUEST HOME
Administrator
EDITHA A. PACLEB
Contact
EDITHA A. PACLEB
License first date
Mar 31, 2007
License effective date
Mar 31, 2007
District office
EL SEGUNDO ASC · (424) 544-1075
Regional office
11
Clients served
985 - RCFE / HOSPICE

Summary

The available records show 2 Type A and 5 Type B deficiencies for this facility.

Most recent inspection
Mar 23, 2026
Most recent deficiency
Mar 23, 2026

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 6 reports for this facility: 6 inspections, 0 complaint investigations, and 0 licensing or administrative records.

Those records contain 2 Type A and 5 Type B deficiencies.

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

Official inspections
6

More than the typical 4

1 in the last 12 months

Recorded deficiencies
7

Well above the typical 1

3 in the last 12 months

Type A deficiencies
2

Most this size have none

2 in the last 12 months

Type B deficiencies
5

Most this size have none

1 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
Facility condition and maintenanceType A
Official classification
Type A
Official code
87303(e)(2)
Regulation authority
CCR

What the official deficiency says

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA identified hot water temperature in bathroom #1 at 158.0 degree F. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2026 Plan of Correction Licensee will contact plumber and adjust the water heater to maintain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). Proof of correction must be sent to LPA a video at ernand.dabuet@dss.ca.gov

Plan of correction recorded
Correction not verified in available records
View official report
Medical and dental careType A
Official classification
Type A
Official code
87465(d)(3)
Regulation authority
CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. Medication for Resident #1 (Potassium Chloride F10MG), Resident #3 (Morphine & Haloperidol PRN), and Resident #5 (Tamsulosin 0.4MG) were not included in the Medication Administration Log. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2026 Plan of Correction Licensee wil ahere to Title 87465 (d)(3) and will ensure that prescribed/PRN medications are included in the resident's and shall be documented and maintained in the resident's records. Licensee agreed to conduct a refresher on medication training. A signed completion of training must be sent to LPA Dabuet at ernand.dabuet@dss.ca.gov

Plan of correction recorded
Correction not verified in available records
View official report
Admission, assessment, and evictionType B
Official classification
Type B
Official code
87458(c)(1)
Regulation authority
CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. LPA identified that Residents #2, #3, and #5 did not have a current Medical Assessment LIC 602A. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2026 Plan of Correction Licensee will ensure that proper annual Medical Assessment LIC 602A for all residents in care. Licensee will provide current medical assessment LIC 602A for resident #2, #3, and #5. Proof of correction must be sent to LPA ernand.dabuet@dss.ca.gov

Plan of correction recorded
Correction not verified in available records
View official report
Inspection
Records and plan of operationType B
Official classification
Type B
Official code
87506(a)
Regulation authority
CCR

What the official deficiency says

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. 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 Residents #1-#5 all had missing or incomplete required CCL forms (See LIC858). This violaton which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction The administrator, shall review the file for R1, ensuring the required documents are filled out and signed in the file. The administrator shall also send a written statement to CCL to the attention of LPA Dabuet that all resident files are complete, and she will ensure that all records/files are complete at times. Proof of correction is due by 02/21/25.

Plan of correction recorded
Correction not verified in available records
View official report
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 the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA identified Resident #3 who is not on hospice with full bedrails without physicians order. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction The administrator, shall review Title 22 Regulation 87608. The administrator shall obtain a written prescription for full bedrails. The administrator shall also send a written statement to CCL to the attention of LPA Dabuet that regulations have been reviewed and a physicians order for full bed rails is obtained. Proof of correction is due by 02/21/25.

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
87411(c)(1)
Regulation authority
CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69.(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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-#4 did not have a current First Aid/CPR Training. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Licensee/Administrator will ensure that all staff involved with resident's daily care must have a current First Aid/CPR training. Proof of correction must be sent to by POC due date: 03/27/24 to ernand.dabuet@dss.ca.gov

Plan of correction recorded
Correction not verified in available records
View official report
Dementia careType B
Official classification
Type B
Official code
87705(c)(5)
Regulation authority
CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: Cross. (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. 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 resident #3 with dementia last medical assessment was in 2021.This violationwhich poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Licensee/Administrator must adhere to Title 22 87705 and ensure any resident with Dementia must have annual medical assessment and reappraisal. Proof of correction must be sent to by due date 03/27/24 to ernand.dabuet@dss.ca.gov.

Plan of correction recorded
Correction not verified in available records
View official 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