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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604628
Report Date: 11/26/2025
Date Signed: 11/26/2025 12:06:39 PM

Substantiated


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
11/18/2025 and conducted by Evaluator David Roman
COMPLAINT CONTROL NUMBER: 08-AS-20251118121433
FACILITY NAME:YAI GARJAN LANE ENHANCED BEHAVIORAL SUPPORTS HOMEFACILITY NUMBER:
374604628
ADMINISTRATOR:AZEEZ LAMINAFACILITY TYPE:
737
ADDRESS:17106 GARJAN LANETELEPHONE:
(341) 201-9993
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:4CENSUS: 2DATE:
11/26/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:DSP Lead, Jamie MidkiffTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff member was impaired while caring for client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Roman conducted an unannounced visit to conduct a complaint investigation and deliver findings in the above complaint allegation. LPA identified himself and discussed the purpose of the visit with Direct Support Professional Lead, Jaime Midkiff.

On November 18, 2025, Community Care Licensing Division (CCLD) received a complaint alleging a staff member was impaired while caring for a client. During the investigation, LPA D. Roman observed pertinent facility records, and conducted interviews with staff.

Regarding the allegation of a staff member being impaired while caring for a client, staff interviews, revealed that S1 was sluggish, slurring their speech, and lethargic due to the misuse of medication. According to facility staff S1 was removed from the floor for their shift, and continues on leave until an internal investigation is completed. Records observed identified S1 was incoherent, removed from the floor, and sent home.
(Cont. on LIC9099-C)

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
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 3
Control Number 08-AS-20251118121433
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: YAI GARJAN LANE ENHANCED BEHAVIORAL SUPPORTS HOME
FACILITY NUMBER: 374604628
VISIT DATE: 11/26/2025
NARRATIVE
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Based on the evidence obtained, the preponderance of evidence standard was met, therefore, the allegation was Substantiated. The deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and is noted on the attached LIC 9099-D. A plan of correction was jointly formulated with the facility.

An exit interview was conducted with DSP Lead, Jaime Midkiff, to whom a copy of this report, LIC 9099D and Licensee/Appeals Rights (LIC 9058) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20251118121433
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: YAI GARJAN LANE ENHANCED BEHAVIORAL SUPPORTS HOME
FACILITY NUMBER: 374604628
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2025
Section Cited
HSC
1569.58(a)(2)
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Persons prohibited from... holding certain positions or employment...(a)...a person who has done any of the following(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility...
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S1 has been placed on leave since 11/17/25. Facility is to conduct an In Service Training regarding Drug Free Work Place Policy. Training Roster to be provided to LPA by POC date.
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This requirement was not met as evidenced by: Based on records and interviews, S1 engaged in conduct that is inimical to the health and safety of 1 of 4 residents in care, This posed a potential risk to the residents in care,
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3