Incident investigation·November 19, 2025

On 11/19/2025 at 2:00 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 11/13/2025. LPA met with Executive Director (ED), Gianni Amari, and explained the purpose of the visit. Death Report (LIC624A) indicated that on 10/28/2025, Resident 1 (R1) was preparing for bed with the assistance of Staff 1 (S1). During middle of conversation, R1 began to shake and became unresponsive. 911 was contacted and R1 was transferred to the hospital. On 10/29/2025, R1 approximately passed away at 1:00 AM. During the visit, LPA reviewed facility’s incident report/ communication log, physician’s report, staff schedule, R1's service plan. LPA interviewed S1 and ED. Interview with S1 and ED revealed that R1 was alert before the paramedics came and as R1 was getting transferred to the hospital. LPA will be requesting for a death certificate. LPA may return at a later time. No deficiency cited during today’s visit. Exit interview conducted and a copy of this report provided.