Alondra Care Home

On 3/9/2026 at 1:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit. LPA met with Administrator, Jezrael Pascual and explained the purpose for the visit. While LPA G. Luk was at the facility for a case management visit, the following deficiency was observed. LPA observed the side gate was locked with a bike lock. Staff removed the lock during inspection. Civil penalty of $250 is being assessed for a repeat violation. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights provided.

On 12/16/2025 at 2:10PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with caregiver, Khin Win and explained the purpose of the visit. While LPA L. Alexander was conducting a complaint investigation (#15-AS-20251211101359 ) on 12/16/2025. During interview with Staff (S1) LPA was informed that Resident (R1) got sick and 911 was called on 12/06/2025. R1 was transported by Emergency Medical Transportation and S1 stated that they were notified by R1's relative that R1 passed away at the hospital. LPA asked S1 if a Unusual Incident Report (UIR) was submitted to Community Care Licensing Division (CCLD) and S1 stated that they had the UIR written but hadn't submitted the document to CCLD. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided

On 12/16/2025 at 3:00 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with caregiver, Khin Win and explained the purpose of the visit. While LPA L. Alexander was conducting a complaint investigation (#15-AS-20251211101359 ) on 12/16/2025. LPA observed latch locks located at the top of the inside doors and fastener holding the dead bolt door locks on exits 1 and 2 per facility sketch. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided

On 3/9/2026 at 11:55AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit in regards to death report received on 2/17/2026. LPA met with caregiver, Sam Htet and explained the purpose of the visit. Administrator, Jezrael Pascual arrived 30 minutes later. Death report stated that staff found resident (R1) not breathing and responding. Staff immediately informed licensee, administrator, and responsible person. LPA interviewed staff and reviewed R1's files. R1's physician's report dated 9/17/2025 stated that R1 had diagnosis of Alzheimer's Dementia, hypertension, diabetes, hyperlipidemia, etc. R1's discharge summary notes dated 2/9/2026 revealed that R1 was discharged with home health care and diagnosis of hypertension, dysphagia, seizure, Alzheimer's Dementia, etc. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Aye, Thinn T - Applicant & Kuppusamy, Nirmala - Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 04/09/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readiness

On today date Licensing Program Analyst (LPA) K. Nguyen conducted a Comp III and met Licensee, Thinn T Aye. After the presentation Licensee stated that Licensee understand the materials that are presented in Comp III. Exit interview conducted and a copy of this report provided via email.

On 5/20/25, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Thinn Aye and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the kitchen sink was measured at 118.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 2/10/25. Emergency Disaster Plan was last reviewed on 5/01/25. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 3/10/25. LPA reviewed 5 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 5/7/2024 at 9:30AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct Pre-licensing Inspection. Upon arrival, LPA met with Licensee, Thinn T Aye, and explained the purpose of the visit. The facility currently has no clients. LPA toured facility including but not limited to 5 bedrooms, 2 half bathrooms, one full bathroom, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 70 degrees F and hot water temperature was maintained at 113.3 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last purchase on 2/17/2024. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided via email.