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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 06/13/2023
Date Signed: 06/13/2023 01:36:18 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
06/07/2023 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230607152031
FACILITY NAME:WOODRUFF CARE HOME INCFACILITY NUMBER:
191592947
ADMINISTRATOR:CARMEN GALICIAFACILITY TYPE:
740
ADDRESS:16409 WOODRUFF AVENUETELEPHONE:
(562) 925-6581
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:88CENSUS: 60DATE:
06/13/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Gemma DeosoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are not meeting resident’s medical needs to obtain a prosthetic device as required by a physician.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Gemma Deoso and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Gemma Deoso, Staff 1-2 (S1-2) and Residents 1-6 (R1-6). LPA collected copies of Staff and Resident rosters. LPA reviewed R1-2's facility files and collected copies of documents relevant to the investigation.



(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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-20230607152031
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: 06/13/2023
NARRATIVE
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Investigation revealed the following: Regarding allegation, Staff are not meeting resident’s medical needs to obtain a prosthetic device as required by a physician, it is alleged that facility staff did not send paperwork needed for R1's doctor appointment and when asked about the paperwork, staff stated that the paperwork was missing. It is also alleged that the doctor's office stated that the paperwork had not been received from the facility. Facility staff allegedly stated that the paperwork was faxed to the doctor's office and is now misplaced and not located by staff. Interviews conducted with Administrator and S1-2 revealed that facility staff schedule medical appointments for residents and ensure that facility residents keep their medical appointments. They stated that the facility also provides transportation for the resident's to get to their appointments. S1 stated that the paperwork that was needed for R1's medical appointment was faxed to the doctor's office and they have a fax confirmation. S1 stated that the paperwork was not missing and was faxed and also emailed to the doctor's office. S1 stated that when they were made aware by R1 that the doctor's office informed them they did not receive the forms, S1 contacted the doctor's office and was informed that they did not receive the paperwork from facility. S1 stated that they then emailed the forms to the doctor's office on 6/8/23, and confirmed that the forms were received. S1 then had to reschedule another appointment for R1 to 6/9/23 due to the forms not completed timely by the doctor. Interview conducted with R1 revealed that the facility did forward the forms to their doctor on 6/8/23 and rescheduled appointment for them for the following day. R1 stated that facility staff (S1) did inform them of the new appointment and they were able to schedule a transportation appointment. R1 stated that they did go to their appointment and they did not have any additional concerns regarding staff not following through with scheduling appointments. Interviews conducted with 5 out of 6 residents revealed that they do not have any concerns with staff not meeting their medical needs and that staff make their medical appointments as well as provide transportation to their appointments or informing them of appointment information so that they can make transportation arrangements. 1 out of 6 residents stated that they do not have any medical appointments at the moment as they are waiting to be approved for medical insurance and stated that they are satisfied with all other services provided by the facility. LPA reviewed documents which show that the facility forwarded the medical forms to the doctor's office for completion. Based on statements gathered from interviews conducted with staff, residents and LPA review of documents, there was not enough supportive evidence to concur with the reported 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.

Exit interview held. A copy of the report was provided to Administrator Gemma Deoso.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC9099 (FAS) - (06/04)
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