198601815-5-21-2026-28-AS-DSIS-DV4Q2C-20260616114652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601815
Report Date: 05/21/2026
Date Signed: 05/21/2026 02:01:39 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/07/2026 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260507060133

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: 4	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Ramon Dy - AM Nurse		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not seek medical attention in a timely manner for residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegation. LPA met with AM Nurse Ramon and explained the purpose of today's visit.

The investigation consisted of the following:
On 5/11/26 LPA conducted initial 10-day visit and obtained copies of the following documents, Client #1 (C1) Temporary Care Plan, RN Assessment and Nursing Notes, Client # 2 (C2) Temporary Care Plan, RN Assessment and Nursing Notes, Restricted Health Care Plan, Recent Hospitalization Records. LPA interviewed 1 Staff (S2), 2 Witness (W1-W2) and attempted interview with C2, at facility during visit. LPA interviewed administrator and C1 via phone calls.
On 5/21/26 LPA reviewed documents provided during initial visit, interviewed Administrator via phone call, completed report and delivered findings on the reported allegation.

(Continued on LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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 28-AS-20260507060133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALFORD HOME	FACILITY NUMBER: 198601815
	VISIT DATE: 05/21/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not seek medical attention in a timely manner for residents in care.
It is alleged that both C1 and C2 were not provided medical attention in a timely manner as C1 was observed with a healing bruise on 04/30/2026 and was not taken to ER/Urgent Care and no care plan has been put in place. It was recommended that C2 received a urinalysis on 3/25/26, and C1 has not received one, on 4/29/26 it was observed that C1 had possible blood in urine (catheter) was taken to the hospital per recommendations from Regional Center representative and it was observed on 5/4/26 when C1 had gone to the hospital that they had a UTI. LPA obtained documents within C1’s file and per the Nursing Notes on 4/30/26 the facility was contacted by C1’s Day Program that bruising was observed on clients foot. The RN assessment dated 4/30/26 that was completed by the facility Registered Nurse did not indicate that there were any skin observations, the note on the skin section of the assessment stated: No skin issues noticed, documentation of bruising began being noted on the assessments beginning 5/2/26. A temporary care Plan for C1 was placed on 5/1/26 to monitor the bruising and swelling. During LPAs visit on 5/11/26 both S1 and S2 stated that C1 has not gone to the hospital to rule out any sign of fracture or advancing injury and they stated that they did not think it was necessary due to C1 stating they are not in pain. C1 is non-ambulatory and requires use of a wheelchair, along with assistance with ADL’s and transfers. Interview with W1 confirmed that on 4/30/26 C1 was observed at day program with bruising and swelling to left foot and facility was notified of the observation. Interview with W2 revealed that when bruising and swelling is observed clients are to be sent to urgent care, hospital or visit primary care physician to ensure that there is no fracture or advance injury present, as clients at ARFPSHN’s (adult residential facility for persons with special health care needs) do not feel pain the way other individuals may. LPA obtained documents within C2’s file and per the Restricted Health Care dated 4/7/26 plan that was provided C2 has a history of UTI, last UTI 2/23/26 – medication was prescribed for 7 days. No follow up visit to ensure that UTI was cleared was provided. During file review LPA discovered C2’s most recent hospitalization (or doctor) is dated 5/4/26, per hospital discharge paperwork C2 tested positive for UTI on 5/4/26 and was prescribed with new medications. Interview with S1 confirmed that C2 has not been taken for a follow up appointment to ensure C2’s UTI is completely gone.
Civil penalty of $250 is being issued for a repeated violation -80075(a)- within same calander year.
Based on LPAs observations, interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099-D. Exit interview held, and a copy of this report and appeal rights were emailed to anahi.murillo_serrano@rescare.com and pua.tata@rescare.com.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260507060133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALFORD HOME	FACILITY NUMBER: 198601815
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/04/2026 Section Cited CCR 80075(a)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	Administrator/Licensee to have C1 visit either urgent care or their primary care physican to esure that C1 does not have any underlying fracture or advance injury to left foot, and C2 visit urgent care or their primary care physican to esure that all signs of UTI are no longer present. Copy of post visit medical documents that state both C1 and C2 do not have fracture/injury/UTI is to be provided to LPA by POC due date via email. tena.herrera@dss.ca.gov
	8 9 10 11 12 13 14	Based on interviews and record review, it was discovered that C1 sustained an injury to their right foot at the facility on 4/30/26 and has not been taken to urgent care, emergency or primary care physician to rule out any fracture or advanced injury. C2 has ongoing UTI's with the most recent hospitalization for UTI dated 5/4/26, since this visit, per interview with S1, C2 has not gone for a follow up visit to ensure that all signs of UTI are gone, this poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
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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: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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