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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601815
Report Date: 04/03/2026
Date Signed: 04/03/2026 04:48:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
03/30/2026 and conducted by Evaluator Blanca Gonzalez
COMPLAINT CONTROL NUMBER: 28-AS-20260330085136
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: 4DATE:
04/03/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Anahi MartinezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not follow reporting requirements
Staff file is incomplete
Staff did not ensure medication was given as prescribed
Staff did not meet client's needs
Staff did not make arrangements for client's medical services
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced initial 10-day complaint investigation visit regarding the above allegations. LPA Gonzalez was greeted by staff, and the purpose of the visit was explained. Administrator Anahi Martinez arrived shortly after.

The investigation consisted of the following: LPA Gonzalez requested and obtained copies of staff roster and client roster. LPA reviewed the following files: facility policy regarding reporting requirements, facility files for staff in-service trainings, facility policy and regarding manual transfer of clients. LPA interviewed staff #1-3 (S1- S3).

continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
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 6
Control Number 28-AS-20260330085136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2026
Section Cited
CCR
80061(b)(1)(E)
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80061 Reporting Requirements (b)Upon the occurrence, during the operation of the facility,...a written report containing the information…shall be submitted to the licensing agency within seven days following the occurrence of such event. (1) Events reported shall include the following:(E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.
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Adminstrator agreed to conduct staff training on reporting requirements including types of incidents to report. Administrator agreed to submit to LPA via email proof of in-service training by POC due date.
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This requirement is not met as evidenced by: Based on interviews and record review, staff did not submit special incident reports regarding client falls.
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Type B
04/24/2026
Section Cited
CCR
80066(a)(6)
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Personnel Records. (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:(6)Documentation of..., training and/or experience specified in licensing regulations for the type of facility in which the employee works.
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Administrator agreed to conduct and document monthly in-service trainings and maintain logs at the facility for review.
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This requirement is not met as evidenced by: Based on LPA record review and interviews, staff was not able to provide documentation for scheduled in-service trainings for August 2025 and November 2025.
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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: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20260330085136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2026
Section Cited
CCR
80075(b)
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80075 Health Related Services . (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
This requirement is not met as evidenced by:
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Adminstrator agreed to provide in-service for staff regarding medication adminstration and proper documentation, and submit t o LPA via email by POC due date.
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Based on record review, on 09/12/25 C1 was not administered prescribed PM nebulizer treatment.
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Type B
04/24/2026
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

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Administrator ensured the facility would obtain a manual Hoyer lift in case the electric lift is not available. Administrator agreed to conduct staff in-service training on manual transfers and provide proof to LPA via email by POC due date.
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This requirement is not met as evidenced by:
Based on interviews, staff was not able to provide documentation and had no explanation for why C3 was not able to be manually transferred.
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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: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20260330085136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2026
Section Cited
CCR
80075(a)
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80075(a) Health Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.
This requirement is not met as evidenced by:
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Corrected by the time of visit. Administrator stated currently two LVNs act as appointment coordinators and provide transportation. Interviews are being conducted to hire appointment coordinator/driver.
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Based on interviews and record review, S3 confirmed that OT was not provided and has not been provided for any clients. S3 stated there was no documentation indicating C2 had received an oncologist recommended DEXA scan.
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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: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20260330085136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
VISIT DATE: 04/03/2026
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Staff did not follow reporting requirements,” it was reported that on 08/05/25, during assisted ADLs, a client (C3) was transferred onto a shower bed that broke, requiring assistance to the floor by 2 staff. The incident was not reported to CCL. On 09/28/25, a client (C1) fell, requiring assistance to the floor. The incident was not reported to CCL. LPA interviewed three (3) staff (S1-S3). 2 out of 3 staff interviewed were not aware of the incidents. S1 stated that on 09/28/25 a temporary care plan had been put in place for C1 due to an “assisted” fall. LPA reviewed facility Incident Reporting policy which indicated any fall must be reported. LPA reviewed CCL’s folder for special incidents reports (SIRs) submitted by the facility and observed SIRs were not submitted to CCL. Staff was not able to provide documentation of the above mentioned incidents being reported to CCL as special incident reports. Deficiency cited and civil penalties are being issued for a repeat violation.

Regarding the allegation “Staff file is incomplete,” it was reported that staff files had no documentation for in-service training November 2025 and December 2025. 3 out of 3 staff interviewed stated they receive monthly on-the-job training. In-service training are 1 to 2 hours and cover various topics including policies and procedures, medication, charting, and client care. LPA reviewed facility file which contained a monthly schedule for in-service training, logs signed by staff in attendance, and included documentation of topics covered. There was no documentation for in-service trainings conducted August 2025 and November 2025. Staff was not able to provide documentation for trainings conducted August 2025 and November 2025. Deficiency cited.

Regarding the allegation “Staff did not ensure medication was given as prescribed,” it was reported that on 09/12/25, a client (C1) did not receive a prescribed nebulizer treatment. LPA reviewed MAR (medication administration records) logs for C1 dated 09/12/15. MAR log for C1 was not initialed for PM administration of nebulizer treatment administration. Staff was not able to confirm PM nebulizer treatment was administered for C1. Deficiency cited.

continued on LIC 9099C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20260330085136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALFORD HOME
FACILITY NUMBER: 198601815
VISIT DATE: 04/03/2026
NARRATIVE
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(page 3)

Regarding the allegation “Staff did not meet client's needs,” it was reported that on C3 could not attend day program approximately 09/12/25 due to a power outage, a Hoyer lift was not functioning and on-site staff was unable to complete manual transfer. 3 out of 3 staff interviewed were not aware of the incident. Staff was not able to provide documentation and had no explanation for why C3 was not able to be manually transferred. Deficiency cited.

Regarding the allegation “Staff did not make arrangements for client's medical services,” it was reported that an oncologist recommended DEXA scan was not completed for (C2), neurologist recommended PT services were not provided between June 2025 and October 2025 for (C1), and orthopedic recommended OT services were not provided for (C1). LPA reviewed summary for neurologist appointment dated 08/29/25. Neurologist placed an order for Occupational Therapy (OT) and Physical Therapy (PT). S1 stated C1 did not want to complete OT or PT but there was no documentation stating client refused therapy. Interview with S3 confirmed that OT was not provided and has not been provided for any clients. S3 stated there was no documentation indicating C2 had received an oncologist recommended DEXA scan. Deficiency cited.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies cited during today’s visit are documented on the LIC9099D pages. A civil penalty in the amount of $250 is being assessed on the attached LIC421FC for repeat violation.

An exit interview was conducted, and a copy of this report, 9099D pages and appeal rights were provided to Director of Nursing Guillerma "Gemma" Mahinan, Administrator Anahi Martinez was unable to stay.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6