019201466-1-22-2026-15-AS-BFOG-DSXMAJ-20260408092626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201466
Report Date: 01/22/2026
Date Signed: 01/22/2026 05:52:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2025 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20250825103605

FACILITY NAME:	ALONDRA CARE HOME 3		FACILITY NUMBER:	019201466
ADMINISTRATOR:	AYE, THINN		FACILITY TYPE:	740
ADDRESS:	27765 DECATUR		TELEPHONE:	(510) 391-1257
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY:	6	CENSUS: 4	DATE:	01/22/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Thinn Aye/Administrator		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Facility does not arrange medical appointment for resident.
Facility does not provide supervision at night resulting in bodily injury.
Licensee treated resident inappropriately.
Staff does not communicate effectively.

INVESTIGATION FINDINGS:

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On this day, January 22, 2026, at 12:30 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegation. LPA was granted entry by staff, Yu Zana, and informed the reason for visit. LPA called and spoke with Thinn Aye, administrator (ADM) who arrived at around 1:05 p.m.

During the course of investigation, LPA reviewed residents' records and obtained copies of including but not limited to the following documents: Admission Agreement; LIC602A Physician's Reports; LIC625 Appraisal/Needs and Services Plan. medical records. LPA also obtained copies of LIC500 Personnel Reports. LPA interviewed the following: residents (R3, R5) and ADM on August 29, 2025 and October 1, 2025; resident (R1) and staff (S1 and S3) on October 1, 2025; first responder (FR) on October 14, 2025.

...continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 15-AS-20250825103605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ALONDRA CARE HOME 3	FACILITY NUMBER: 019201466
	VISIT DATE: 01/22/2026

NARRATIVE

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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

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20250825103605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ALONDRA CARE HOME 3	FACILITY NUMBER: 019201466
	VISIT DATE: 01/22/2026

NARRATIVE

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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.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

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