198601815-10-23-2025-28-AS-WSHO-DMYM4N-20251031091702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601815
Report Date: 10/23/2025
Date Signed: 10/23/2025 02:27:54 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 HOME		FACILITY NUMBER:	198601815
ADMINISTRATOR:	MATTHEW MAILANGKAY		FACILITY TYPE:	734
ADDRESS:	165 ALFORD ST		TELEPHONE:	(909) 599-7403
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	5	CENSUS: 5	DATE:	10/23/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	MATTHEW MAILANGKAY		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility did not meet client needs
Staff did not report incident
Facility is in disrepair

INVESTIGATION FINDINGS:

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The purpose of this report is to change the initial Substantiated findings from 09/18/2025 regarding the allegation Facility is in financial distress. Findings will be changed to Unsubstantiated. At today's visit 10/23/2025 interviews were conducted with Staff S1- Staff S3. On 09/18/2025 the following was done:
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.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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 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: 10/23/2025

NARRATIVE

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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.
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.

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.

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.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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 HOME		FACILITY NUMBER:	198601815
ADMINISTRATOR:	MATTHEW MAILANGKAY		FACILITY TYPE:	734
ADDRESS:	165 ALFORD ST		TELEPHONE:	(909) 599-7403
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	5	CENSUS: 5	DATE:	10/23/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	MATTHEW MAILANGKAY		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility is in financial distress

INVESTIGATION FINDINGS:

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The purpose of this report is to change the initial Substantiated findings from 09/18/2025 regarding the allegation Facility is in financial distress. Findings will be changed to Unsubstantiated.
At today's visit Staff S1- S3 were interviewed and a tour of the facility was conducted which included 5 Client Bedrooms and 2 Client Bathrooms. Kitchen was also inspected which included observation of the food supply.
In regards to the allegation Facility is in financial distress, at today's visit there was sufficient lighting in Client Bedrooms and throughout the facility.
There was a sufficient supply of 2 day perishables and 7 day non-perishables.
Medication was in full supply for all the clients.
Staff S1- S3 stated that the power outage was just a 1 time thing that happened.
Also all 3 staff stated that they always received their paycheck with no interruption and that the
utilities were always operating and there was always food and medication for all clients.
There is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the
allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3