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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604628
Report Date: 12/09/2025
Date Signed: 12/09/2025 11:38:50 AM

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
08/27/2025 and conducted by Evaluator David Roman
COMPLAINT CONTROL NUMBER: 08-AS-20250827093352
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:
12/09/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Facility Manager, Zach McCormickTIME COMPLETED:
11:31 AM
ALLEGATION(S):
1
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9
Staff member did not accord dignity to resident in care.
INVESTIGATION FINDINGS:
1
2
3
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5
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9
10
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12
13
Licensing Program Analyst (LPA) David Roman conducted a telephone call to deliver findings in the above complaint allegation. LPA identified himself and discussed the purpose of the phone call with Facility Manager, Zach McCormick.

On August 27, 2025, Community Care Licensing Division (CCLD) received a complaint alleging facility staff did not accord dignity to a resident in care. During the investigation, LPA D. Roman collected pertinent facility records, and conducted interviews with staff. Interviews revealed the intentions of the incident in which staff attempted to clean a resident to prevent further contamination. Based on evidence obtained, the preponderance of evidence standard was not met, therefore, the allegation was unsubstantiated.

An exit interview was conducted with Facility Manager, Zach McCormick, to whom a copy of this report and Licensee/Appeals Rights (LIC 9058) were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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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