Brooklyn Home Care

Allegation investigated: Facility lacks sufficient staffing to meet resident's needs

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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 28, 2026 · control 22-AS-20260122080653

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Elma Ilagan. Licensee Ervin Bumanglag arrived at approximately 1:30 p.m. and the purpose of the inspection was discussed. During the inspection, LPA and Staff Ilegan conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story house with four resident bedrooms, one staff room, two bathrooms, and attached two car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents engaging in bingo in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Medication was observed to be centrally stored and locked. LPA reviewed four resident files and three staff files. Three of three staff files did not contain a health screening which includes a chest x-ray or an intradermal test, performed by a physician; a Deficiency was cited on today's date. LPA interviewed residents and staff. Based on the observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Required - 1 Year

On September 26, 2024, at 8:00am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Yolanda Terencio. LPA Kim spoke with Licensee Arvin Bumanglag over the phone and explained the purpose of the visit. LI Bumanglag arrived at the facility around 9:15am. The facility is licensed to operate for five (5) nonambulatory residents one (1) bedridden and have a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Herondelles Cateman. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 115.5 degrees F to 116.2 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke/carbon monoxide detectors were operable. A working telephone (714-203-1366) remains available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen, and bought on May 9, 2024. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S5), and medication and medication administration review. LPA Kim conducted one (1) staff interview. A deficiency was cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Arvin Bumanglag.the state’s words, verbatim · CDSS document, Sep 26, 2024