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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604113
Report Date: 07/08/2025
Date Signed: 07/08/2025 02:15:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2021 and conducted by Evaluator Donna Teutschel
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210211090825
FACILITY NAME:LA COSTA VILLASFACILITY NUMBER:
374604113
ADMINISTRATOR:LEKOVIC,DRAGANAFACILITY TYPE:
740
ADDRESS:7619 PRIMAVERA WAYTELEPHONE:
(760) 521-0303
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:3CENSUS: 3DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Alexandar BoskoskiTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide incontinence care to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stacy Barlow
LICENSING EVALUATOR NAME: Donna Teutschel
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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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