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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 12:05:20 PM

Document Has Been Signed on 05/07/2024 12:05 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Thinn T Aye, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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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.
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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