191592947-3-29-2023-28-AS-RORN-CRPTAB-20230510143317

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:48:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
03/28/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230328111454

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: 59	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Asst. Administrator, Gemma DeOso		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are verbally abusing residents in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above allegation. LPA met with Staff #1 (S1) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained Resident & Staff Rosters, In-service training/meeting record (Report suspected Abuse of Dependent Adults & Elders/Mandated Rights, Personal Rights). LPA also toured the facility with the Asst.Administrator which included all the common areas and a random sample of resident bedrooms. LPA also interviewed Staff #1 - Staff #5 and Resident #1 (R1) - Resident # 6 (R6). LPA attempted to interview night shift Staff #6 (3x), (2:15pm, 3:54pm and 4:17pm) and left a voice mail message, but S6 did not return the call.
*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 28-AS-20230328111454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WOODRUFF CARE HOME INC	FACILITY NUMBER: 191592947
	VISIT DATE: 03/29/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigation revealed the following:

Regarding allegation: "Staff are verbally abusing residents in care." All of the staff interviewed denied the allegation. Staff members stated that they treat all residents with respect and do not verbally abuse residents. Interviewed staff indicated they have not seen, heard or observe staff verbally abusing residents. 3 out of 5 staff members interviewed indicated that it was the residents who were verbally abusive to staff and not the other way around. Interviewed staff also indicated that hey are trained in Resident Rights, Personal Rights and Mandated Reporting. Interviewed residents indicated that staff are not verbally abusive. All 6 of the residents interviewed stated that the staff are not verbally abusing them nor have observed any staff verbally abusing other residents in care. S5-S6 stated that staff in the facility are pleasant and attend to their needs. Staff interviews, resident interviews and reviewed documentation do not corroborate this allegation.

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.

No deficiencies cited. Exit interview and a copy of this report were provided to the Facility Assistant Administrator, Gemma DeOso.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2