Alondra Care Home 3

Allegation: Facility does not arrange medical appointment for resident. R1 stated she has medical conditions and needs to see a doctor but the administrator (ADM) does not want to assist. ADM stated stated R1 has not asked her to assist in medical appointments because R1 does it herself and needs to have ambulance for the transport. ADM also stated they assist R1 in picking-up R1's medications. LPA was not able to confirm whether or not R1 needs assistance because there's no LIC602A Physician's Report which according to ADM R1 does not want to provide, therefore the allegation is unsubstantiated. Allegation: Facility does not provide supervision at night resulting in bodily injury. R1 stated that on August 2025, R2 fell and there was no staff to assist. R1 called the staff but no response, so R1 end up calling 9-11. R3 and R5 stated they were not residing at the facility on the time the incident happened. Review of R2's record showed R2 has sundowning behavior. LPA was not able to obtain information from R2 due R2's medical condition. The first responder (FR) who confirmed attending to 9-11 call stated R2 was still on the floor when they arrived and no caregiver present. The 2 staff interviewed stated there was no staff assigned at night when the incident happened. Although information obtained by LPA confirmed there was no staff present when R2 fell, however, review of medical record showed R2 did not sustain injury, therefore, the allegation is unsubstantiated. Allegation: Licensee treated resident inappropriately. R1 stated the licensee who is also the administrator (ADM) threatened to evict R1 when R1 did not want to move to Oakland to be the house manager of licensee's other facility. ADM stated her business partner is opening an independent living home in Oakland and that she (ADM) asked R1 to move to that location and be the house manager because R1 told her that R1 was a house manager before and been doing it for years. ADM stated that in the beginning R1 said yes then changed mind and said she does not want to move to Oakland. R1 is paying only $1400/month because R1 is independent. ADM stated she gave R1 a notification in August 2025, but she didn't make a copy of the notification. Therefore, the allegation is unsubstantiated. ....continued on 9099C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff does not communicate effectively. R1 stated S4 does not know how to speak English. ADM stated S4 knows how to speak English and S4 only worked for 2, 3 days. ADM futher stated that all her staff understand and although they are not fluent, know how to speak English. LPA interviewed S1 and S3 in English and observed them able to communicate. LPA was not able to interview S4. Therefore, the allegation is unsubstantiated. Based on interviews and records review, the 4 allegations are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. ADM has to leave and authorized Mya 'Clara' Thazin to sign and receive this report. No deficiency cited. Exit interview conducted and copy of this report provided.

On this day, January 22, 2026, while at the facility investigating complaints (Control #'s 15-AS-20250825103605 and 15-AS-20250924164748), Licensing Program Analyst (LPA) Delmundo met with staff (S1). S1 stated she started working yesterday and on this day. LPA checked Guardian Portal no fingerprint clearance and not associated to this facility. LPA also observed Advil in the family room and tree trimmer in the backyard. LPA also observed Thinn Aye (ADM) had an argument with resident R1 when R1 told LPA that ADM said an inappropriate words to R1. LPA has to break the argument and talked to ADM in the family room. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $250.00 civil penalty is assessed for deficiency section # 87455(e)(2) . Failure to submit proof of corrections by plan of correction due dates and any repeat violation may result in additional civil penalty. Deficiencies, plan and proof of corrections and civil penalty were discussed with ADM. ADM has to leave and authorized Mya 'Clara' Thazin to sign and receive this report. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty, LIC9098 Proof of Correction and copy of this report provided.

While at the facility conducting inspection with Thinn Aye, administrator (ADM), for investigation of a complaint (Control # 15-AS-20250825103605), Licensing Program Analyst (LPA) Delmundo observed dividing walls and 2 beds in the garage. After granting of fire clearance by fire department on 1/22/25, and before granting of license, pre-licensing inspection was conducted by LPA on 3/13/25. LPA observed rooms with permanent walls installed in the garage. LPA reached out to fire marshal, and ADM had the rooms demolished. LPA reached out to fire marshal again regarding the dividing walls installed in the garage. Per fire marshal, the dividing walls are not allowed and that the demolition of the walls on the garage and the explanation of not using it as habitable space was conveyed prior.The garage can only be used if permitted and constructed per code, otherwise, it should remain a garage. On this day, 10/01/25, LPA learned and observed resident (R1) has 5 and 1 scratches/wounds on the lower right arm and left arm respectively caused by the dog in the facility. ADM stated the incident happened 2 days ago. On this same day, 10/01/25, the same dog came inside the facility and kept jumping on LPA. LPA also observed resident (R2) with two half bed rails on one side of the R2's bed, and R2 is not on hospice. .......continued on 809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Deficiencies, plan and proof of correction and civil penalty were discussed with ADM. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided

Licensing Program Analyst (LPA) Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Thinn Aye, applicant-administrator. LPA presented the training via Power Point presentation and had a discussion with the applicant-administrator. Exit interview conducted and copy of this report provided at the conclusion of the training.

While at the facility conducting investigation of a complaint (Control # 15-AS-20250825103605), Licensing Program Analyst (LPA) Delmundo observed during inspection, review of records and interviews the following which LPA discussed with Thinn Aye, administrator (ADM). -at 12:48 pm, side fence gate locked. -no file/record for resident (R1). ADM stated R1 does not have file/record. -no LIC9020 Register of Facility Clients/Residents -two residents (R2 and R3) were sent out to the hospital and administrator did not submit LIC624 Unusual Incident Reports. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section # 87203. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in additional civil penalty. Deficiencies, plan and proof of corrections and civil penalty were discussed with ADM. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment and copy of this report provided,