374604552-5-7-2025-08-AS-SJAB-DGQU3A-20250516151309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604552
Report Date: 05/07/2025
Date Signed: 05/07/2025 06:38:29 PM

Unsubstantiated

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
08/30/2023 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20230830072340

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:	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	LIcensee/Administrator Alex Limpin		TIME COMPLETED:	11:59 AM

ALLEGATION(S):

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Unlawful Eviction
Staff neglect resulting in Injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to deliver findings for a complaint investigation for the above-mentioned allegation. LPA identified herself, disclosed the purpose of the visit and was allowed entry by community manager Jamila Hallak. LIcensee/Administrator Alex Limpin later joined the visit.

The Department’s investigation consisted of a records review, interviews and LPA observations. On 08/30/2023 it was alleged that Client #1 (C1) received an unlawful eviction and staff neglect resulted in the injury of C1. LPA Rodgers made observations, conducted interviews and reviewed facility records. [See LIC811 Confidential Name List for identification of select person identifiers used in this report].

Regarding the alligation of C1's unlawful eviction. More specifically, C1 was admitted to the hospital on 8/22/2023 and was ready to be released on 08/28/2023, but the facility refused to accept the client back due to medication non-compliance. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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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Control Number 08-AS-20230830072340

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: 05/07/2025

NARRATIVE

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(CONTINUED FROM LIC 9099)
A records review revealed that an admissions agreement was entered into between the facility and C1 on 8/1/2023. A records review and department interviews revealed that a thirty-day (30) eviction notice was not issued to C1 and C1’s responsible parties. Records review reveal there was not a specific time in place for C1 departure from C1 hospitalization as of August 28, 2023. Department interviews with staff confirmed they received a call from the hospital asking to take C1 back to the facility in August 2023; however, interviews with staff and the administrator did not deny or confirm that they refused C1's entry back to the facility. An email was sent by the Administrator to the department stating C1 was admitted back to the facility on 9/17/2023.

it was further alleged that staff neglect resulted in injury. More specifically, Client #1 (C1) was covered in dry feces and had substantial bruising to his left hip and skin tears. A records review reveals C1 began residency on 8/1/2023 at the facility after an extended stay at the hospital. According to the physician's report dated 7/12/2023, C1 was diagnosed with Alcoholic Cirrhosis and paranormal AHIB, chronic pain syndrome, and type 2 diabetes. The physicians report further reveal C1 does can not have a bowel impairment, can be irritable at times, with no physical aggression, and does need assistance with medication. A review of hospital records reveals C1 does have a history of bowel problems, including constipation as well as loose bloody stools. The records also indicate a history of diabetic ulcers to one toe; skin tears to left forearm, wounds to the feet, elbows, and wrists, dating from 7/13/23 to 7/28/23 all noted before residence at the facility on 8/1/2023. Interviews with staff and records review reveal C1 was sent to the hospital by the facility on 8/22/2023. Nursing orders dated 8/28/23 to 9/17/2023 reveal a sitter requested due to aggressive behavior, scratching at skin tears, head CT showed no acute trauma. Hospital records did not indicate any further information about left hip bruising.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during interviews, records review, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

An exit interview was conducted with the Administrator to whom a copy of this report and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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