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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604628
Report Date: 08/14/2025
Date Signed: 09/03/2025 01:09:32 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
05/23/2025 and conducted by Evaluator David Roman
COMPLAINT CONTROL NUMBER: 08-AS-20250523090959
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:
08/14/2025
UNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Assistant Program Administrator, Zach McCormick TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Manual restraint was used on a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Roman conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified himself and discussed the purpose of the visit with Assistant Program Administrator, Zach McCormick.

On May 23, 2025, Community Care Licensing Division (CCLD) received a complaint alleging a manual restraint was used on a resident. During the investigation, LPA D. Roman collected pertinent facility records, conducted interviews with staff, and outside sources.

Regarding the allegation of a manual restraint was used on a resident, interviews with external sources, and facility staff, revealed that an unauthorized manual restraint was used on a resident to preserve their life. The restraint was not utilized in a malicious intent. Staff interviews revealed the use of manual restraints to preserve the residents life during an emergency. According to staff the restraint was utilized in attempts to prevent resident 1 (R1) from eloping into traffic. Records collected identified the use of the restraint. (Cont. on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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-20250523090959
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: 08/14/2025
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 Assistant Administrator, Zach McCormick.

An exit interview was conducted with Assistant Administrator, Zach McCormick, 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: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250523090959
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: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2025
Section Cited
CCR
89990(b)
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(b) An Enhanced Behavioral Supports Home licensed as a Group Home shall not use manual restraint on a client unless and until an Emergency Intervention Plan has been developed by the licensee and approved by the Department pursuant to the California Code of Regulations...
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The facility conducted a debriefing meeting on 05/21/2025 to discuss alternative strategies, authorized holds, and revise functional behavioral assessments (FBA) and other behavioral/educational assessments and PRN during doctor transitions.
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Based on observation, interviews, and record review, the facility utilized an unauthorized hold on 1 of 2 persons in care which posed a potential health, safety, personal rights risk to the person 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: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3