191592947-2-2-2023-28-AS-LHIS-CRBMM2-20230428094311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:43:54 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, 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
01/25/2023 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20230125151435

FACILITY NAME:	WOODRUFF CARE HOME INC		FACILITY NUMBER:	191592947
ADMINISTRATOR:	CARMEN GALICIA		FACILITY TYPE:	740
ADDRESS:	16409 WOODRUFF AVENUE		TELEPHONE:	(562) 925-6581
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	88	CENSUS: 56	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Administrator Carmen Galicia		TIME COMPLETED:	02:58 PM

ALLEGATION(S):

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Staff mismanaged resident's medication
Staff do not respond to resident's call for assistance

INVESTIGATION FINDINGS:

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On 02/02/23 at 9:26 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with Carmen Galicia (Administrator) and explained the purpose of the visit.

During today’s visit LPA and administrator toured the facility and tested the call button in rooms 110, 113, 119, 129, 132, 233 and 246. LPA obtained resident/ staff roster, Resident #1 Physicians report, Photo of R1's medication and Resident #1 Physicians orders. LPA also interviewed: Administrator and a total of two (2) staff who shall be referred to as S1, and S2. LPA interviewed a total of 6 residents who shall be referred to as: R1 through R6.

Report continued 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20230125151435

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: 02/02/2023

NARRATIVE

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The investigation reveals the following: Regarding " Staff mismanaged resident's medication", it is alleged that the facility is not administering resident medication correctly. During the visit LPA reviewed R1’s physicians orders and confirmed the medications orders state the starting time for the medication to be given, but do not specify how much time the medication should be given before meals. LPA also observed the medication bottle states before meals and at bedtime. Administrator and 1/2 staff interviews confirmed R1 receives the medication but refuses when it is not exactly 1 hour before meals. Administrator and staff explained to resident that the orders state before meals, but not 1 hour before meals. Although it does not state 1 hour before staff has accommodated the resident. 1/2 staff do not work with R1 and medications. 4/6 residents stated they do not have any issues with there medications. 1/6 residents stated the facility has made mistakes in the pass with their medication but has always adjusted when brought to their attention. 1/6 residents stated the facility has recently administered the medication right, but in the past the facility was not administering the medication 1 hour before meals.

The investigation reveals the following: Regarding "Staff do not respond to resident's call for assistance “, it is alleged that the facility is not answering the call light. During the tour LPA tested the call button and all was in working condition. During the test the facility staff responded in three (3) minutes or less. The administrator stated when a resident pulls the cord, an alarm tells the staff which room need assistance. The administrator further stated that they never had any residents complain about staff not responding. 2/2 staff stated they have always responded to the residents and have not heard the residents complain about not getting assistance. 5/6 residents confirmed the facility staff has always responded in a timely manner when they need assistance. 1/6 residents stated staff do not come when they pull the cord for assistance.

Based on LPA's observation, interviews, and file review the 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 allegations are UNSUBSTANTIATED.

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

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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