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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601815
Report Date: 09/18/2025
Date Signed: 09/18/2025 05:01:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/17/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250917121135
FACILITY NAME:ALFORD HOMEFACILITY NUMBER:
198601815
ADMINISTRATOR:MATTHEW MAILANGKAYFACILITY TYPE:
734
ADDRESS:165 ALFORD STTELEPHONE:
(909) 599-7403
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:5CENSUS: 5DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Michael MailangkayTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Facility did not meet client needs
Staff did not report incident
Facility is in disrepair
Facility is in financial distress
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Michael Mailangkay and explained the reason for the visit.
The purpose of the visit is to investigate the above allegations.
At today's visit staff and resident roster was submitted.
Tour of the facility was conducted and included the following:
The facility is a single-story home, operating as an Adult Residential Facility for Persons with Special Health Needs. It is licensed to serve (5) adults, ages 18-59. There is a fire clearance approved for (5) bedridden adults.
Medication was locked and inaccessible to clients and staff and clients files were also locked in the storage cabinet.
Inspection of the kitchen and food supply were conducted and contained sufficient supply of 2 day perishables and 7 day non-perishables.
Interviews were conducted with Staff S1-S4 and also with the Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 5
Control Number 28-AS-20250917121135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
VISIT DATE: 09/18/2025
NARRATIVE
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Interviews were conducted with Client's C1 and C2.
Attempted interviews were conducted with Client's C3- C5 who were unable to respond to questioning.
In regards to the allegation Facility did not meet client needs, based on interviews conducted and information gathered Client's C1 and C2 stated that clients had to leave this facility because it was all dark because power was off. Client C1 stated being scared and did not get the nebulizer breathing treatment at 8PM on Friday the day they relocated.
Interview with Staff S1- S4 who all stated the residents had to be relocated because of there not having power.
Staff S1 also stated that R1 did not get a breathing treatment at 8PM due to the relocation and packing.
Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.

In regards to the allegation Staff did not report incident, based on interviews conducted and information gathered Administrator confirmed that Special Incident Report (SIR) was not submitted to Licensing at Department of Social Services.
Stated that they did send to Regional Center 5 reports with it being 1 for each client.
Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.


In regards to the allegation Facility is in disrepair, based on interviews conducted and information gathered, interviews with Staff S1 and Staff S2 who stated that the back up generator was in need of replacement and facility brought in a new generator.
Administrator confirmed that the back up generator was not in good repair and a new generator was purchased
LPA observed the new generator in the garage.
Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250917121135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
VISIT DATE: 09/18/2025
NARRATIVE
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In regards to the allegation Facility is in financial distress, interview with Administrator who stated that the electricity had been turned off because of an outstanding bill owed of 2K.
Stated it has been paid and provided verification of payment in the amount of $2,440.75 paid on 9/15/25 which is the day that the clients who relocated came back to the facility.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20250917121135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2025
Section Cited
CCR
80072(a)(2)
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Personal Rights
Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
to be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Admimistrator to conduct a training regarding disaster and evacuation and submit by POC due date.
Facility conducted on 9/17/25 training on Evacuation and Disaster Plan and Generator use and maintenance.
Deficiency cleared.
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This requirement is not met as evidenced by:
Licensee failed to ensure clients safe, healthful and comfortable accommodations with clients having to be relocated which posed an Immediate Health and SafetyRisk to clients in care.
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Type B
09/22/2025
Section Cited
CCR
80061(b)(1)(E)
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Reporting Requirements
Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event.
Events reported shall include the following:
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Facility to submit Special Incident Report (SIR) by POC due date.
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Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.
This requirement is not met as evidenced by:
Facility did not submit report to Licensing regarding power outage which posed a potential risk to clients 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: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250917121135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2025
Section Cited
CCR
80087(a)
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Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement is not met :
Based on interviews conducted and observation licensee failed to ensure good repair at all times which posed an Immediate Health and Safety to clients in care.
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Facility to ensure that the backup generator is replaced by a new generator by POC due date.
Administrator and staff stated backup generator was replaced and LPA observed the new generator in the garage.
Deficiency cleared.
Deficiency Dismissed
Type A
09/19/2025
Section Cited
CCR
80062(a)(1)
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Finances
The licensee shall meet the following financial requirements:
(1) Development and maintenance of a financial plan which ensures resources necessary meet operating costs for care and supervision of clients.
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Administrator to submit verification that past due bill was paid in full.
Administrator showed LPA verification of electricity bill payment.

Deficiency cleared.
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This requirement is not met as evidenced by:
Based on interviews and review licensee failed to meet financial requirements by not paying the electricity bill for 3 months which posed an Immediate Health and Safety Risk to clients 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: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5