374604552-9-28-2023-08-AS-IESA-CW85U3-20231001201516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604552
Report Date: 09/28/2023
Date Signed: 09/28/2023 07:33:44 PM

Unfounded

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
09/27/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20230927093131

FACILITY NAME:	ACORN OAKS MANOR II		FACILITY NUMBER:	374604552
ADMINISTRATOR:	LIMPIN, ALEXANDER		FACILITY TYPE:	740
ADDRESS:	6217 ACORN ST		TELEPHONE:	(619) 777-9674
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	14	CENSUS: 12	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Staff, Jamila Hallak		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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-Personal Rights
-Personal Rights
-Staff did not provide timely assistance to resident in care
-Licensee did not follow reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Staff, Jamila Hallak.

During today's visit, LPA briefly toured the facility, interviewed staff, and requested records. Mulitple allegations were reported, as listed above. Evidence obtained during the investigation indicated the allegations were pertaining to a specfiic resident. Staff interviews revealed that specific resident resided at a different location.

Based on interviews, we have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Staff, Jamila Hallak whose signature below confirms receipt of these rights.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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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