191592947-10-29-2020-28-AS-MVAO-BXMVVG-20210126154618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 09/28/2020
Date Signed: 10/29/2020 11:16:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/04/2020 and conducted by Evaluator Shawna Day

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200604075649

FACILITY NAME:	WOODRUFF CARE HOME INC		FACILITY NUMBER:	191592947
ADMINISTRATOR:	SANCHEZ, CHANEL		FACILITY TYPE:	740
ADDRESS:	16409 WOODRUFF AVENUE		TELEPHONE:	(562) 925-6581
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	88	CENSUS: 69	DATE:	09/28/2020
		UNANNOUNCED	TIME BEGAN:	11:34 AM
MET WITH:	Chanel Sanchez		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Facility has bed bugs

Facility has lice

Facility has roaches

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Day conducted a subsequent tele visit to the facility to further investigate the above allegations. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically.
During this investigation LPA interviewed staff #1 - #4, including Administrator and residents #1 - #7. LPA virtually toured the kitchen, lobby area, TV room and dining room.

FACILITY HAS BED BUGS
The investigation revealed that the Administrator noticed bed bugs in two rooms . Immediately Admiral pest control was called and sprayed while facility staff cleaned and replaced linen and mattresses. The facility began deep cleaning the entire room 2-3 times a week. Staff also had neighboring rooms sprayed and deep cleaned as a precaution although no signs of bed bugs was observed. LPA observed contract and invoices from pest control services to be conducted monthly.
Based on the information gathered and the interviews conducted the LPA finds that the facility acted appropriatley and timely when notified of bed bugs in the facility. The facility did not neglect nor ignore the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Shawna Day	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020

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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Control Number 28-AS-20200604075649

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WOODRUFF CARE HOME INC	FACILITY NUMBER: 191592947
	VISIT DATE: 09/28/2020

NARRATIVE

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the problem and has worked to resolve the issue. Therefore the LPA finds this allegation to be UNSUBSTANTIATED

FACILITY HAS VERMIN
The investigation revealed the following: All staff and residents interviewed were consistent in their statements that they have not seen any vermin in the facility. There are traps throughout the facility in inconspicuous places, set by the pest control as a precaution with the pest service. The pest control has a contract with the facility for monthly services .The LPA finds that there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

FACILITY HAS LICE
The investigation reveled the following: R#1 was found to have lice by physician, the physician prescribed Rid Lice shampoo. Immediately as a precaution prescriptions were given individually to all residents, which were treated for two weeks with the rid shampoo. LPA finds that the Administrator acted immediately and responsibly for the residents in care. LPA finds that there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Shawna Day	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

LIC9099 (FAS) - (06/04)

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