La Costa Villas

Allegation investigated: Absence of Supervison Inadequate food service

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on a complaint investigation. LPA Hurt met with, Administrator, Dragana Lekovic, and explained the purpose of today’s visit. On 11/23/2021, LPA conducted an unannounced visit to the facility and interviewed residents, staff, and the administrator. Residents interviewed, including Resident 1, Resident 2, and Resident 3, stated that staff are available when assistance is needed. Residents reported that they are able to call for help and that staff respond when called, including during nighttime hours. No resident reported being left alone without staff present. Unsubstantiated The facility administrator, stated that staff coverage is maintained at all times. Staff schedules were reviewed, and staff were identified as working during both daytime and nighttime hours. While it was alleged that the licensee’s father was present in the home, there was no evidence to support that residents were left without appropriate supervision. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated Regarding the allegation inadequate food service. During the visit on 11/23/2021, LPA observed meals being prepared and served. Lunch served during the visit consisted of beets, a turkey sandwich with tomatoes and mayonnaise, and clam chowder. The administrator stated that meals are rotated weekly based on resident preferences and that residents may request alternative meals. Residents interviewed reported that the food was adequate and that they received enough to eat. Residents stated that they are able to request different food items if desired. One former resident (Resident 4 ), who moved out of the facility in May 2021, reportedly complained about food; however, no current residents corroborated concerns regarding inadequate food service. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated Exit interview conducted with Administrator, Dragana Lekovic, and copy of report provided.the state’s words, verbatim · CDSS document, Feb 20, 2026 · control 08-AS-20210409164946

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

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 (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.the state’s words, verbatim · CDSS document, Aug 19, 2025 · control 08-AS-20250711100600

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Nacole Patterson and Jose De La Cruz conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by and discussed the purpose of the visit to the licensee, Aleksandar Boskoski (AB). The facility's license shows a maximum capacity of 3 non-ambulatory residents over 60 years of age. During today’s inspection there was one resident in care. LPAs and AB toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored on the second floor of the building. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. A gated pool with a 5 foot locked gate was on the premises, inaccessible to residents. Per AB, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed staff and clients, and reviewed facility records. The files reviewed by LPAs contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with AB to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with Administrator Dragana Lekovic, to discuss the purpose of the visit. During an unrelated facility investigation LPA directly observed a baby monitor in a resident's room (R1), that included a sound component. Interviews revealed that the monitor was being used during the evenings when staff were upstairs, so they could be aware if R1 called for assistance. LPA provided education regarding resident privacy in accommodations and the baby monitor was unplugged and removed from the room. During the visit Administrator confirmed that the call button for the resident was in working order and would be used in addition to regular supervision checks and resident care. LPA conducted a wellness check at the facility; no health or safety issues were identified. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Administrator Dragana Lekovic, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Jul 25, 2025

87468.2(a)...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1)To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communication...This requirement was not been met as evidenced by: Based on observation/interviews, Licensee did not comply with the section cited above in that a baby monitor with an audio component was present and operational in a client room, posing a potential personal rights risk to 1 of 2 clients in care.the state’s words, verbatim · CDSS document, Jul 16, 2025

Plan of correction: Administrator immediately removed the monitor from the resident's room during the visit. A plan was created with LPA during the visit regarding how staff will hear and respond to client call buttons in the evening. Administrator will review Personal Rights with Staff via in-service and provide proof of training via sign-in sheet by POC due date.

Allegation investigated: Staff did not provide incontinence care to resident.

LPM II, RA Donna Teutschel conducted a telephone conference with Administrator, Aleksandar Boskoski, Based upon the numerous statements obtained to date, there is nothing to verify that any instance of lack of care to any resident who requires incontinent care. The Department is unable to prove or disprove the above allegation and the finding is deemed to be Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 8, 2025 · control 08-AS-20210211090825

Allegation investigated: Facility does not have a qualified and currently certified administrator.

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 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.the state’s words, verbatim · CDSS document, Sep 5, 2024 · control 08-AS-20240829114239

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Caregiver Diana Cisneros. The facility's license shows a maximum capacity of three (3) non-ambulatory residents, ages 18-59. During today’s inspection there were three (3) residents in care. LPA and caregiver Diana Cisneros toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. The facility has a pool that was inaccessible to residents with a locked fence. Per caregiver Diana Cisneros, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. During the visit the Administrator scheduled an appointment for the fire extinguisher to be serviced on 6/27/24 and will provide proof to LPA. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with caregiver Diana Cisneros to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jun 25, 2024