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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604554
Report Date: 06/21/2022
Date Signed: 06/21/2022 03:34:19 PM


Document Has Been Signed on 06/21/2022 03:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 IIIFACILITY NUMBER:
374604554
ADMINISTRATOR:LIMPIN, ALEXANDERFACILITY TYPE:
740
ADDRESS:6209 ACORN STTELEPHONE:
(619) 777-9674
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:6CENSUS: 0DATE:
06/21/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Administrator Alexander LimpinTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA), Kayla Hilario, conducted an announced case management visit to amend a prelicensing report that was created on 06/07/2022. LPA identified herself, discussed the purpose of the visit and met with Administrator Alexander Limpin.

During the visit, LPA explained the amended 809 Prelicensing Facility Visit Report. An exit interview was conducted with Administrator Alexander Limpin. The amended report, Licensee Rights (LIC 9058 01/16), and a copy of this report was provided to via hardcopy at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Kayla HilarioTELEPHONE: 619-481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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