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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201341
Report Date: 05/07/2024
Date Signed: 05/07/2024 12:04:54 PM

Document Has Been Signed on 05/07/2024 12:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ALONDRA CARE HOMEFACILITY NUMBER:
019201341
ADMINISTRATOR/
DIRECTOR:		KUPPUSAMY, NIRMALAFACILITY TYPE:
740
ADDRESS:1643 101ST AVETELEPHONE:
(510) 509-4635
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY: 6CENSUS: 0DATE:
05/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Thinn T Aye, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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