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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602565
Report Date: 01/14/2026
Date Signed: 01/14/2026 03:21:01 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2026 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20260106095207
FACILITY NAME:AVOCADO CREEKFACILITY NUMBER:
374602565
ADMINISTRATOR:MARIJA BANOVICFACILITY TYPE:
740
ADDRESS:1080 AVOCADO AVETELEPHONE:
(760) 822-5860
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:12CENSUS: 10DATE:
01/14/2026
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator Marija BanovicTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff did not ensure that a resident was provided with a safe environment
INVESTIGATION FINDINGS:
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On 01/14/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to investigate the allegation listed above. LPA met with Administrator Marija Banovic who was informed of the purpose of the visit.

LPA toured the facility, conducted interviews, and obtained copies of pertinent documentation. Regarding the allegation, “Staff did not ensure that resident was provided a safe environment” it was alleged on 01/02/2026 and 01/04/2026, Resident 1 (R1) reported wanting to get a gun to kill Resident 2 (R2). It was further alleged on 01/03/2026, R1 slapped R2 in the facility.

During the tour, LPA did not observe any firearms in the home. LPA reviewed an Unusual Incident/Injury Report (LIC 624) dated 01/03/2026 documenting on 01/02/2026 at 1:20 p.m. Staff 1 (S1) and a nurse observed R1 stand up from a reclining chair in the living room, begin walking towards R2, and slapped R2 for no reason. The LIC 624 documents police were called and R1 was transported to the hospital by police on 01/04/2026.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
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 3
Control Number 18-AS-20260106095207
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AVOCADO CREEK
FACILITY NUMBER: 374602565
VISIT DATE: 01/14/2026
NARRATIVE
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S1 was interviewed and reported the following information. The incident occurred on 01/02/2026 not 01/03/2026 as alleged and was an isolated incident involving R2. On 01/02/2026, S1 was speaking with a hospice nurse in the kitchen when they observed the incident as described in the LIC 624. S1 and the nurse immediately responded to the scene, separated and redirected the residents, assessed R2 for injuries/pain, and called law enforcement and Administrator Banovic. R1 claimed to have a gun and threatened to kill R2. However, R1 does not own a gun, nor did they have the means to go out to purchase one. R1 has resided in the facility since October 2025 and prior to this incident, R1 had not exhibited any signs of aggression in the past. Law enforcement and administrator responded to the facility, and law enforcement determined that due to R1’s cognitive impairment and limited physical capabilities, R1 was not realistically able to gain access to a firearm to carry out the threat. Law enforcement advised S1 to follow up with the Crisis Response Team (CRT) and request an evaluation for R1. Law enforcement determined it was safe for R1 remain in the facility pending CRTs evaluation. As a result, S1 was assigned by administrator to provide 1:1 care and supervision to R1 to ensure the safety of R2 and the remaining residents pending the CRTs evaluation results. A witness interview was conducted with the hospice nurse identified from the LIC 624. This witness corroborated the information provided by S1 and added they also assessed R2 for injuries. The witness reported they have visited R2 in the facility twice a week since 02/01/2025 and have never witnessed R1 or any other resident make verbal threats or display physical aggression towards R1 or other residents. Administrator was interviewed, corroborated the information provided by S1 and added the following information. There are no firearms stored in the facility. On 01/03/2026, S1 contacted CRT due to R1 aggressing towards staff. Law enforcement responded to the facility and determined it was safe for R1 to remain in the facility pending their CRT evaluation scheduled for 01/04/2026. On 01/04/2026, R1 was hospitalized as a result of the CRT evaluation. Administrator reported they ensured the safety of all residents in care and even offered R1 a private room to avoid further possible incidents by residing with a roommate, to which R1 accepted. Administrator maintained contact with R1’s responsible person who was in the process of arranging for R1 to also be evaluated by their primary care physician. LPA conducted an interview with R1’s responsible person who reported facility staff have done a fantastic job despite current difficult circumstances. R1’s responsible person reported prior to this incident, R1 did not display any aggression. They reported R1 does not own a firearm, has never touched one, and is not able to gain access to one.
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20260106095207
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AVOCADO CREEK
FACILITY NUMBER: 374602565
VISIT DATE: 01/14/2026
NARRATIVE
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LPA reviewed R1’s signed physician’s report dated 10/23/2025 documenting R1 has dementia. The “Expressions of Frustration” subsection in R1’s physician’s report is marked “No”. This subsection is nested under the category “Behavioral Expressions” defined as behavior(s) displayed by a resident that may result in harm to self or others. LPA reviewed a letter from the Department of Justice dated 01/05/2026 addressed to R1 prohibiting them from possessing or gaining access to a firearm or any other deadly weapon beginning 01/04/2026 to 01/04/2031. R1 refused to be interviewed. LPA conducted an interview with R2 who recalled the incident as described in the LIC 624 and reported S1 ran to the incident location to intervene and assess them for injuries. R2 reported they did not experience any verbal threats or physical aggression from R1 or any other residents in the home prior to this incident. R2 reported S1 offered them immediate medical attention to which R2 declined. LPA made contact with the reporting party who reported facility staff intervened and responded appropriately to the incidents involving R1 and R2. LPA was unable to identify any additional possible witnesses. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report and Confidential Names list (LIC 811) was reviewed and provided to Administrator Banovic.
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3