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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603838
Report Date: 09/28/2022
Date Signed: 09/28/2022 04:31:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/17/2020 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20200617143944
FACILITY NAME:ACORN OAKS MANOR IIFACILITY NUMBER:
374603838
ADMINISTRATOR:CHEN, HATTIEFACILITY TYPE:
740
ADDRESS:6217 ACORN STTELEPHONE:
(619) 265-8416
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:0CENSUS: 0DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
04:17 PM
MET WITH:Closed Facility - Report sent via USPS Certified MailTIME COMPLETED:
04:29 PM
ALLEGATION(S):
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Facility is malodorous.

Facility is unkempt.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura sent this report to the Licensee's last known mailing address, via USPS certified mail, to deliver the investigation findings for the above listed allegations. The facility changed ownership on June 15, 2022.

Community Care Licensing (CCL) has investigated the allegations identified above. The investigation consisted of a virtual tour of the facility and interviews of facility staff and outside sources.

It was reported to Community Care Licensing that on one occasion during a visit to the facility, the facility was found to be unkempt and malodorous. Based upon LPA’s observation and interviews conducted during the investigation, evidence was not obtained to conclude that the facility has been maintained in an unkempt manner. Additionally, interviews conducted did not reveal evidence to conclude that the facility was malodorous. Due to a lack of evidence to corroborate the allegations, the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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 2
Control Number 08-AS-20200617143944
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ACORN OAKS MANOR II
FACILITY NUMBER: 374603838
VISIT DATE: 09/28/2022
NARRATIVE
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Although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Due to the facility’s closure, no exit interview was conducted. Copies of this report and Licensee Rights (LIC 9058) were mailed via USPS certified mail to the last mailing address on file.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2