374604113-9-5-2024-08-AS-JLOT-D9JKS9-20240928080911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604113
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:58:51 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
08/29/2024 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240829114239

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: 3	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator/Licensee Aleksander Boskoski		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility does not have a qualified and currently certified administrator.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit. LPA Silveira introduced themselves, met with Caregiver Dianna Cisneros and disclosed the purpose of the visit. Licensee/Administrator Aleksander Boskoski arrived shortly after. The purpose of the visit was to conduct a complaint investigation.

The Department’s investigation consisted of LPA observations, interviews and records review. On 08/29/24, It was alleged that the facility does not have a qualified and currently certified administrator. A records review revealed that there are currently two certified Administrators at the facility. The Administrator’s active certificates were posted and their names were present on Community Care Licensing’s Administrator Certificate Bureau’s Active Certificate List. (CONTINUED ON NEXT PAGE, LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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-20240829114239

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: 09/05/2024

NARRATIVE

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An interview with Administrator #1 (A1) revealed that A1 lives at the facility and currently provides caregiving services to the residents in the evenings and on the weekends. A1 is the Licensee and has worked as a Administrator/Caregiver at the facility since 2018. An interview with Staff #1 (S1) revealed that A1 is present at the facility daily in the afternoons providing caregiving services. An interview with Resident #1 (R1) revealed that R1 was familiar with A1 and R1 stated that A1 was present at the facility frequently providing caregiving services. LPA observations during a facility tour also revealed that residents were clean and well cared for. There were no health or safety concerns.

Due to a lack of corroborating evidence, the allegation that the facility does not have a qualified and currently certified administrator is unsubstantiated. There is not a preponderance of evidence to prove that the alleged violation occurred.

LPA Silveira conducted an exit interview with Aleksander. At the time of the exit interview, Aleksander was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 03/22). The signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

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