PACIFIC HOME CARE
ICF/DD-N (Nursing) · 6 licensed beds · Carson, CA
Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.
Address
PACIFIC HOME CARE254 E 228TH STCarson, CA 90745 · Los Angeles CountyPhone: (310) 513-1684
State penalties
4
Class 4 B
Federal surveys
18
since 2018 · 10 with deficiencies
Federal deficiencies
55
2 condition-level
Last federal survey
Jun 16, 2026
survey date
Facility details
- Facility type
- ICF/DD-N (Nursing)
- Licensed beds
- 6
- Licensee
- Not named in CDPH's listing (Individual). CalHealthFind shows ownership.
- Administrator
- TANGLAO, ROSELINE B
- CDPH facility ID
- 960002393
- License number
- 960001097
- First licensed
- February 23, 1999
- Current license
- May 27, 2026 to May 26, 2027
- CDPH district office
- La Icf/Dd/Clinics
Federal certification (CMS)
- CMS Certification Number (CCN)
- 55G248
- Status in CDPH's listing
- Licensed And Certified
- Program
- Medi-Cal (Medicaid, Title XIX)
- Participating since
- May 6, 1999
- Last certification survey
- May 3, 2025
- CMS certification status
- Certified
- In compliance (CMS)
- Yes
- Last certification action
- Recertification
- Ownership type (CMS)
- Private (proprietary)
- Certified beds (CMS)
- 6
- Staffing reported to CMS
- RN 0.38 · LVN/LPN 0.7 · direct care 8 · all employees 10.08
State citations and penalties (CDPH)
CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained
Class BPhysical Environment
Citation B (HSC 1424) · Violation Aug 2, 2017 · Penalty #960013493 · Survey LC9J11
Status: Closed · Not appealed
$1,000
Class BPatient Care
Citation B (HSC 1424) · Violation Feb 1, 2008 · Penalty #960004784 · Survey D78Z11
Status: Closed · Not appealed
$1,000
Class BPatient Care
Citation B (HSC 1424) · Violation Jul 29, 2003 · Penalty #960001033
Status: Closed · Not appealed
$1,000
Class BStaffing
Citation B (HSC 1424) · Violation Jul 29, 2003 · Penalty #960001030
Status: Closed · Not appealed
$1,000
Federal inspections (CMS-2567)
CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection
Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").
· Recertification
Event 22ED7B-H1 · no deficiencies cited
· Complaint
Event 7RL511 · no deficiencies cited
· Complaint
Event 8K3Q11 · no deficiencies cited
· Complaint
Event BZB311 · no deficiencies cited
· Complaint
Event XHUR11 · no deficiencies cited
· Complaint
Event 0GL711 · no deficiencies cited
From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.
Complaints and reported incidents
CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.
Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.
Open this facility on CalHealthFind ↗How to file a complaint with CDPH
Change history
23 events, newest first
Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.
ReportFederal survey (complaint): 2 deficiencies(state record)
See this survey →ReportFederal survey (recertification): no deficiencies(state record)
See this survey →ReportFederal survey (recertification): 4 deficiencies(state record)
See this survey →ReportFederal survey (complaint): no deficiencies(state record)
See this survey →ReportFederal survey (complaint): no deficiencies(state record)
See this survey →ReportFederal survey (complaint): no deficiencies(state record)
See this survey →ReportFederal survey (recertification): 6 deficiencies(state record)
See this survey →ReportFederal survey (recertification): 3 deficiencies(state record)
See this survey →ReportFederal survey (complaint): no deficiencies(state record)
See this survey →ReportFederal survey (complaint): no deficiencies(state record)
See this survey →
Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.