374604113-8-19-2025-08-AS-SMAZ-DMFUWL-20251014155651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604113
Report Date: 08/19/2025
Date Signed: 08/19/2025 02:40:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2025 and conducted by Evaluator Nacole Patterson

COMPLAINT CONTROL NUMBER: 08-AS-20250711100600

FACILITY NAME:	LA COSTA VILLAS		FACILITY NUMBER:	374604113
ADMINISTRATOR:	LEKOVIC,DRAGANA		FACILITY TYPE:	740
ADDRESS:	7619 PRIMAVERA WAY		TELEPHONE:	(760) 521-0303
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92009
CAPACITY:	3	CENSUS: 1	DATE:	08/19/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Aleksandar Boskoski, Licensee		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff did not attend to resident's call for assistance.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Nacole Patterson and Jose De La Cruz conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPAs introduced themselves and disclosed the purpose of the visit to Licensee Aleksandar Boskoski.

On 07/11/2025 it was alleged that staff did not attend to Resident 1's (R1) call for assistance. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Three (3) of three staff interviewed informed that R1 was assisted at all times of the day when they called. Staff informed that R1 had a pendant, which they used regularly, and that the layout of the facility was such that staff were directly outside of R1's room during the day and could easily hear them when they needed help. Staff additionally informed that the Licensees lived on the second floor of the facility and provided care at night when R1 pushed their pendant for help. Staff informed that R1 was assisted timely every time they pushed their pendant or requested help from staff.

(Continued on LIC9099-p.2)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250711100600

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LA COSTA VILLAS	FACILITY NUMBER: 374604113
	VISIT DATE: 08/19/2025

NARRATIVE

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(Continued from LIC9099-p.1)

LPA interviewed R1 during an unannounced facility visit. R1 did not express concerns about living in the facility and informed that staff were nice and responded to their requests for assistance.

Outside sources interviewed did not corroborate the allegation, informing that residents were treated well at the facility and due to having a capacity of three, residents were tended to quickly. Outside sources did not express concern about staff response times to residents' requests for help. Additional inquiries to relevant outside sources were not returned responded to.

Records review revealed screenshots of the common area facility footage showing staff providing care to residents at night. The screenshots showed staff attending to Residents on 07/16/25 at 04:43am, 07/15/25 at 05:13am, 07/15/25 at 10:09pm, 07/13/25 at 01:21am, 07/11/25 at 01:27am. Outside source records from R1's hospice agency were reviewed; the records were absent of concerns regarding supervision at the facility or response to requests for help from residents.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Aleksandar Boskoski, Licensee, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

LIC9099 (FAS) - (06/04)

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