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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435294143
Report Date: 11/10/2025
Date Signed: 11/12/2025 11:41:48 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2025 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20251002125338
FACILITY NAME:SOUTH COUNTY RETIREMENT HOME INC.FACILITY NUMBER:
435294143
ADMINISTRATOR:APOSTOL, SAMUEL C.FACILITY TYPE:
740
ADDRESS:460 CHURCH AVENUETELEPHONE:
(408) 683-0229
CITY:SAN MARTINSTATE: CAZIP CODE:
95046
CAPACITY:46CENSUS: 43DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Samuel C. ApostolTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident sexually abusing another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to deliver the finding of the complaint investigation that was received by the Department on 10/02/25.

On 10/03/25, the Department conducted a 10-day visit at the facility and gathered information.
On 10/20/25, the Department continued the investigation and interviewed resident (R1) other residents and staff.

Based on interview R1 could not provide the current date and time. When questioned about the details of the sexual abuse by another resident at the facility and beaten by an adult female R1 could not provide details or information on the incidents. When asked if the person was R1s roommate, R1 is not able to provide any identifying information. R1 stated that a person who sexually assaulted him/her was from a year ago while at the hospital. R1 could not give any information of who assaulted him/her at the hospital.

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Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 26-AS-20251002125338
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: SOUTH COUNTY RETIREMENT HOME INC.
FACILITY NUMBER: 435294143
VISIT DATE: 11/10/2025
NARRATIVE
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Based on the document review, R1 does not take his/her medication at home resulting to a severe schizoaffective disorder, bipolar and catatonia. R1 has history of mental illness, R1 is able to ambulate and is able to leave the facility unassisted as stated on his/her physician's report (LIC 602). R1 has mild cognitive disorder. R1 was admitted to the hospital from 02/06/25 and was discharged on 07/17/25. R1 was admitted due to history of odd behaviors and changing cognition. R1 moved to the facility after discharged from the hospital.

Based on observation. LPA observed at the time of the visit on on 10/03/25, that R1 called a family member and alleges that he/she was being maltreated. Family called the facility and ADM assured R1s family member that R1 is unharmed. At the same time R1 called his/her case manager from Telecare and stated that there is an emergency happening at the facility. R1s CM called the facility to confirm, ADM assured CM that R1 is unharmed and no emergency or EMT personnel is at the facility. R1 approached LPA and stated to LPA that he/she was beaten on his/her arms, shoulder, body. LPA did not observed any bruising on R1s arms or legs. R1 followed LPA while LPA was conducting inspection of the facility on 10/03/25. LPA did not observed R1 to be in pain.

Based on interview, observation and document review, the department has investigated the complaint alleging that, staff did not provide adequate supervision resulting in resident sexually abusing another resident. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies were cited during today's visit based on the California Code of Regulation (CCR) Title 22. An exit interview was conducted with LIC/ADM Samuel Apostol and a copy of the report was provided.

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end of report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2