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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005815
Report Date: 01/28/2026
Date Signed: 01/28/2026 11:58:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/22/2026 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20260122080653
FACILITY NAME:BROOKLYN HOME CAREFACILITY NUMBER:
306005815
ADMINISTRATOR:CRUZ, CHONA M.FACILITY TYPE:
740
ADDRESS:902 BROOKLYN AVENUETELEPHONE:
(714) 203-1366
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: DATE:
01/28/2026
UNANNOUNCEDTIME BEGAN:
12:33 PM
MET WITH:TIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility lacks sufficient staffing to meet resident's needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to complete the 10-day visit and deliver the findings. Upon arrival, LPA Haddadin was granted entry and greeted by the caregiver on duty, Elma Ilaggan.
It was alleged that “Facility lacks sufficient staffing to meet resident's needs.” At the time of the visit, LPA Haddadin observed four residents in care and two caregivers on duty. The facility’s current capacity is six. LPA Haddadin conducted three resident interviews and two staff interviews; all interviewees denied the allegation. One resident could not be interviewed because the resident was non-verbal and medically unable to provide a reliable statement. During record review of the caregiver schedule, LPA Haddadin observed staffing that reflected two caregivers on duty during the day shift and one caregiver on duty during the night shift. Based on interviews, observations, and record review, the preponderance of evidence standard could not be met. Therefore, the allegation “Facility lacks sufficient staffing to meet resident's needs” is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to facility staff.





Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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