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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:43:44 AM

Unsubstantiated


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
09/16/2022 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20220916162018
FACILITY NAME:WOODRUFF CARE HOME INCFACILITY NUMBER:
191592947
ADMINISTRATOR:SANCHEZ, CHANELFACILITY TYPE:
740
ADDRESS:16409 WOODRUFF AVENUETELEPHONE:
(562) 925-6581
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:88CENSUS: 56DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Carmen GaliciaTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff sexually abused resident
INVESTIGATION FINDINGS:
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On 11/03/2022 at 9:15 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the allegations listed above. LPA met with Administrator Carmen Galicia and explained the reason for the visit. The initial complaint visit was conducted on 9/20/2022.

During the initial visit LPA Baptiste conducted a health and safety check. LPA conducted a tour of the facility, inside and out. LPA requested copies of staff and resident roster along with Resident #1 (R1) Face sheet, Psychiatric assessment dated 5/12/2020, Physicians’ orders dated 7/12/22, Resident assessment, Individualized service plan and Physicians report. LPA also obtained Resident #2 (R2) Face sheet, Physician’s report dated 7/06/2022, Resident assessment, Individual Service Plan, Comprehensive assessment dated 5/13/22, Physicians orders dated 8/7/022 and Order Summary Report from Valley Convalescent Hospital.

Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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-20220916162018
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: 11/03/2022
NARRATIVE
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Investigation consisted of the following: CDSS IB investigator accepted the complaint as an assignment. The investigator interviewed Resident # R1 and R2. On today’s visit LPA obtained a copy of in-service training for mandator reporting and LPA interviewed administrator and Staff #1 through Staff#3. LPA also interviewed Residents# 3 through Residents#5.

Per IB Investigator, it was revealed that resident/victim(R1) denied abuse by anyone within the facility. R1 further stated to the investigator that they feel safe and happy living in the facility. IB investigator interviewed R2 and it was revealed that R2 never witness abuse at the facility but was told by R1 that they do not like when a male care staff changes their diaper. LPA interviewed administrator and confirmed that the facility was made aware from a resident that they have reported abuse to CCLD. The administrator stated that they immediately investigated, and the resident denied any form of abuse. The facility then conducted in-service training with staff on mandatory reporting. 3/3 staff denied the allegation and confirmed that male care staff have a female care staff with them during diaper changes. 5/5 residents interviewed denied witnessing or experiencing any form of abuse at the facility. 3/3 residents further confirmed that male care staff has a female care giver in the room during diaper changes. 4/5 residents stated they felt safe at the facility.

Based on LPA's interviews, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.



Exit interview conducted with Carmen Galicia and a copy of this record provided.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
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