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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604552
Report Date: 03/05/2025
Date Signed: 03/05/2025 02:40:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
02/26/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250226105852
FACILITY NAME:ACORN OAKS MANOR IIFACILITY NUMBER:
374604552
ADMINISTRATOR:LIMPIN, ALEXANDERFACILITY TYPE:
740
ADDRESS:6217 ACORN STTELEPHONE:
(619) 777-9674
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:14CENSUS: 9DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Community Manager, Jamila HallakTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensee did not provide safe and healthful living accommodations
Facility in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation regarding the above mentioned allegations. LPA met with Community Manager, Jamila Hallak. Administrator, Alex Limpin arrived during the visit.

During the investigation, the facility was toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged the licensee did not provide safe and healthful living accommodations for residents due to a rat/rodent infestation. Outside source photo evidence was provided for room #8 that showed rat droppings in resident’s room, in the dresser drawer, on the resident’s clothing, behind the dresser, and a resident’s shoe that had bite marks with a piece torn off. The administrator explained observing a rodent on the outside of the facility back in January 2025. Therefore, they contacted a pest control company. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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 3
Control Number 08-AS-20250226105852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ACORN OAKS MANOR II
FACILITY NUMBER: 374604552
VISIT DATE: 03/05/2025
NARRATIVE
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The Pest control records dated 01/23/25, which was the initial inspection, indicated heavy rodent activity found in all 5 houses; multiple trees were found touching the roofs, which allow rodents to enter through the holes/vents on roof; multiple holes (14 in total) and openings were found around the property; window screens were not properly in place providing access to rodents; and air vents were not secured also allowing access to rodents. The the pest control records dated 01/23/25 also indicated service provided included 13 rodent bait stations, rodent trapping for 30 days, and monthly service. On 02/21/25, the pest control company returned and documented 7 rats were captured in the attic spaces and pest findings in the laundry area. The facility submitted an incident report with incident dated 02/19/25 regarding rat/rodent droppings in the closet of a resident’s room, reported by a resident’s family member.

Today, 03/05/25, LPA observed rat droppings in rooms #3 and #8. Also observed was a door in room #3 leading to outside that had a large gap under the door and a hole visible from the outside. There was a towel placed on the floor in front of the gap under the door. In addition, there was a hole covered by a piece wood behind a resident’s bed. The administrator explained the wood was placed there due to the bed banging against the wall creating a hole, not due to the rats. Resident interviews confirmed the rat activity in their room along with the rat droppings. A review of Centers for Disease Control (CDC) online search indicated rat droppings are harmful and can cause serious illness. The administrator explained staff vacuumed, used bleach and disinfectant to clean the rat droppings. The administrator was advised not to vacuum, per CDC guidelines and follow CDC protocols, the administrator agreed. Staff interviews revealed some residents like to keep their door open which leads to outside. LPA explained residents are allowed to leave their door open. However, mitigation is still required by patching up the holes and/or openings ensuring they are sealed, which will assist with rats/rodents entering the facility. The administrator explained the pest control are coming to the facility monthly and will continue as prevention until eradication.

It was also alleged the facility was in disrepair due to the room #8 ‘s bathroom shower not working, shower head broken, no toilet set, and shower floor having dark marks of debris. The administrator explained the residents do not use that shower, only the toilet. Administrator also explained the repair order was in their que for repairs, as they were aware. Outside source photo evidence revealed the shower head was broken, no toilet seat, and the shower flooring had marks and dirt. Staff interviews confirmed the shower in room #8 was not working, as the resident uses the other shower. Resident interviews confirmed being unable to shower in that bathroom. Today, 03/05/25, LPA observed the bathroom needed an overall cleaning, shower needed to be repaired, shower floor needed cleaning, and toilet seat was missing.

Based on observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Community Manager, Jamila Hallak whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250226105852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ACORN OAKS MANOR II
FACILITY NUMBER: 374604552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/02/2025
Section Cited
CCR
87464(f)(2)
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Basic Services. Basic services shall at a minimum include: Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services. This requirement is not met as evidenced by:
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Administrator stated pest control is involved and will continue. In addition, administrator agreed to repair all the holes and openings inside the facility, clean and disinfect rooms according to CDC guidelines by POC due date.
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Based on observations and interviews the licensee did not provide safe and healthful living accommodations for 9 out of 9 residents (R1-R9), which poses a health and safety risk to residents in care.
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Request Denied
Type B
04/02/2025
Section Cited
CCR
87303(e)(6)
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Maintenance and Operation. Water supplies and plumbing fixtures shall be maintained as follows: Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment... Ambulatory residents, based on the residents' needs.
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Administrator stated the bathroom will be cleaned and maintained in working order by POC due date.
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This requirement is not met as evidenced by: Based on observations and interviews the licensee did not maintain bathroom in operating condition for 2 out of 9 residents (R1-R2), which poses a health and safety risk to residents 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.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3