374604552-7-16-2025-08-AS-SJAB-DK4UVU-20250731155543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604552
Report Date: 07/16/2025
Date Signed: 07/16/2025 08:16:24 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
05/01/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20250501084930

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: 3	DATE:	07/16/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Community Manager Jamila Hallak		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not ensure that resident is able to make and receive confidential phone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Amy Rodgers, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Community Manager Jamila Hallak , who identified herself and disclosed the purpose of the visit.

The Department’s investigation consisted of a review of records and interviews with internal and external sources.

On May 1, 2025, Community Care Licensing (CCL) received a complaint alleging that licensee staff do not ensure that residents can make and receive confidential phone calls. More specifically, the licensee staff told the reporting party they could not speak with Resident #1(R1) or visit R1 without R1's power of attorney permission.
(Continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025

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-20250501084930

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: 07/16/2025

NARRATIVE

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(continued form LIC 9099)

During the investigation, interviews were conducted with multiple residents who stated they are able to both make calls and receive calls freely and without staff interference. Staff interviews, including Staff #1(S1) and Staff #2(S2), confirmed that residents are encouraged to maintain communication with family and friends and are provided access to upon request. Interviews with the Administrator revealed ongoing communication with R1's responsible party as well as one of R1's family members, regarding communication between family/friends and residents. Interviews with Outside Sources were inconsistent; however, Outside Source #3(OS3) submitted a recorded conversation regarding an attempt to contact R1 through the facility phone. Records review indicates that S2 responded appropriately in accordance with R1's right to privacy and confidentiality of personal health information, as outlined in Title 22, California Code of Regulations.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee did not ensure the facility was free of odors from incontinence. The allegation is, therefore, Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted over the phone with Administrator/Licensee Alexander “Alex” Limpin as well as in person with Community Manager Jamilla Hallack to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025

LIC9099 (FAS) - (06/04)

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