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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603838
Report Date: 07/08/2024
Date Signed: 07/08/2024 01:48:37 PM

Substantiated


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
05/10/2021 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20210510135446
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:
07/08/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:N/A. Report Certified Mailed to Licensee.TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee used cameras which capture audio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen concluded an investigation regarding the above prior complaint allegation. Since the facility ceased operations on 06/15/2022 due to Change in Ownership, the allegation finding was delivered to the Licensee via USPS certified mail.

The Complainant alleged that Licensee used cameras in common areas of the facility which captured audio (not just video). CCLD’s investigation involved an unannounced facility tour/welfare check, review of the facility’s Admissions Agreement, and interviews of facility managers and frontline staff.

Interview of facility manager confirmed that Licensee employed cameras in facility common areas which captured audio of conversations, not just video. Interviews of multiple frontline care staff corroborated this. The facility’s Admissions Agreement also referenced use of cameras at the facility which capture audio.

[CONTINUED ON LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
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 5
Control Number 08-AS-20210510135446
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: 07/08/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

CCLD Evaluator Manual’s Reference Material Section 2-5800 titled “Guidelines for Video Surveillance” states: “Under no circumstances may video surveillance in facilities use an audio component.” According to Regulation 87468.2(a)(1), residents of RCFE facilities shall have the right to “a reasonable level of personal privacy in accommodations…visits, communications, telephone conversations…and meetings…”

Based on records and interviews, a preponderance of evidence exists to show that Licensee used cameras which captured audio, violating residents’ right to privacy. The allegation is therefore Substantiated, and one (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). Since the facility has closed and ceased operations, no Plan of Correction was formed with the Licensee.

A copy of this report, the LIC9099-D page, and the Licensee/Appeal Rights (LIC9058 03/22) were mailed to the Licensee’s last known address via USPS certified mail.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20210510135446
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2024
Section Cited
CCR
87468.2(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(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…visits, communications, telephone conversations…and meetings…”
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Since the facility has closed and ceased operations, no Plan of Correction was formed with the Licensee.
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This requirement was not met, as evidenced by: Based on records and interviews, Licensee did not ensure that 14 of 14 residents (R1 through R14) had a reasonable level of personal privacy in accommodations, visits, communications, telephone conversations, and/or meetings. This posed a potential personal rights risk to persons 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/10/2021 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20210510135446

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:
07/08/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:N/A. Report Certified Mailed to Licensee.TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Licensee did not ensure incontinence care supplies were available to resident(s).
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen concluded an investigation regarding the above prior complaint allegation. Since the facility ceased operations on 06/15/2022 due to Change in Ownership, the allegation finding was delivered to the Licensee via USPS certified mail.

The Complainant alleged that Licensee did not ensure incontinence care supplies were available to residents, because there were multiple occasions when Licensee did not timely restock/replenish them. For this investigation, CCLD conducted an unannounced facility tour/welfare check, then interviewed nine (9) direct care staff and four (4) residents.


[CONTINUED ON LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20210510135446
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: 07/08/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

All nine (9) direct care staff said Licensee consistently kept enough incontinence supplies on hand at the facility and restocked them often enough, such that they never ran out of any incontinence supply item when it was need by any resident. Of the four (4) residents interviewed, three confirmed that they themselves wore Depends, whereas the fourth did not require Depends. All residents interviewed for this complaint told CCLD they had not heard about or seen facility staff running out of incontinence supplies for residents to use.

Based on LPA observation and interviews, there does not exist a preponderance of evidence to prove that Licensee did not ensure incontinence care supplies were available to residents. The allegation is therefore Unsubstantiated, and no deficiency was cited for it.

A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were mailed to the Licensee’s last known address via USPS certified mail.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5