Facility Evaluation Report
On November 19, 2025 at 8:45am, Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Incident visit in regards to an Incident Report the Department received on 11/18/2025. LPA met with Administrator Sam Apostol and stated the purpose of the visit.
On 11/18/2025, the Department received an LIC 624 Incident Report stating on 11/17/2025 resident R1 was found unconscious and staff called 911 in response and R1 was transported to the hospital. Administrator Sam Apostol was informed R1 passed away at the hospital the same day.
During today's visit, LPA Rai received information from Administrator, Sam Apostol and two staff members.
LPA Rai obtained a copy of R1's ID and Emergency Information and LPA Rai received copies of R1's Appraisal/Needs and Services Plan and R1's Physician's Report.
At this time, LPA Rai determined this case management needs further investigation. Administrator Sam Apostol will provide a copy of R1's Death Report when it becomes available.
This report was reviewed with Administrator Sam Apostol and a copy of the report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction