191592947-6-5-2023-28-AS-DSIS-CTHUDF-20230707152929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 06/05/2023
Date Signed: 06/05/2023 03:51:38 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
05/31/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230531105328

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:	06/05/2023
		UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Administrator, Gemma Deoso		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure hot water is available to residents
Staff do not maintain resident bathroom in clean and sanitary condition
Staff do not provide soap to resident
Staff allow residents to smoke in non-designated areas

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Bennette Pena conducted a 10-day complaint visit to investigate the allegations listed above. LPA met with Administrator, Gemma Deoso and explained the purpose of the visit. Administrator and S1 assisted LPA Pena with the visit.

The investigation consisted of the following: LPA obtained copies of Resident & Staff Rosters, Plumber's invoice dated 3/16/2023, random resident admission agreement, House rules and Housekeeping job description. LPA toured the facility’s common areas such as residents rooms, bathrooms and designated smoking areas with S1. Between 11am-11:50am, LPA conducted the hot water temperature check in (8) random residents’ rooms on the first and second floor, (Room numbers: 107, 110, 116, 129, 235, 236, 240, 242). At 2:30pm, LPA measured and inspected (3) random residents rooms (Room numbers: 121, 126 & 127) using an infrared thermometer to measure the room temperature (photos taken). LPA interviewed the Administrator, Staff #1 (S1) – Staff #4 (S4), telephonically interviewed Staff #5 (S5) and Resident #1 (R1) – Resident #10 (R10). ***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: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

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 3

Control Number 28-AS-20230531105328

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: 06/05/2023

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

The investigation revealed the following:

Allegation: Staff do not ensure hot water is available to residents. It is alleged that there is no hot water available in the resident’s bathroom sink. Administrator was interviewed at 10:35 am. Administrator indicated that the facility does not have an ongoing issue with hot water. She stated that the boiler was serviced and repaired in March 2023 and has been fixed since. Administrator also stated that she was not aware of any complaints from the residents, staff or family members about the facility not delivering hot water. Maintenance staff was telephonically interviewed and confirmed the hot water was serviced and there is no issues with hot water in the residents rooms. Facility staff were also interviewed, and they indicated that there were no issues with residents' hot water in their rooms. Between 11am-11:50am, LPA tested the hot water in (8) random residents’ rooms on the first and second floor and hot water temperature read between 112.8 deg F-118.3 deg F which is within the required 105 - 120 degrees. LPA interviewed residents between 12:00pm-12:45pm and none of the residents indicated there was an issue with the hot water. LPA also reviewed a copy of the receipt for water heater serviced on 3/16/2023. The receipt indicates that the water heater was cleaned and repaired.

Based on observation, statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

· Allegation: Staff do not maintain resident bathroom in clean and sanitary condition. It is alleged that a bathroom inside the resident’s room looks like the toilet has never been cleaned. Additionally, there’s human waste in the toilet and staff said they do not have a housekeeper right now for cleaning. Interviews conducted with staff members indicated that the residents’ rooms are cleaned daily. Administrator stated that the facility has housekeepers maintain overall cleanliness and orderliness of residents’ rooms. Interviews conducted with staff indicated that the housekeepers follow the daily schedule to thoroughly clean the residents’ rooms. Staff members denied the allegation and stated that they help each other and assist the housekeepers with cleaning if needed. At 2:30pm, LPA along with the Administrator checked (3) random residents rooms using an infrared thermometer to measure the residents room temperature. The room temperature measured between 74-78 degrees which is within Title 22 Regulations requirement. LPA observed the rooms to be in a comfortable temperature for residents. Interviews conducted with residents indicated that their rooms are cleaned daily, beddings/linens changed and they don’t have any issues or concerns. LPA observed staff conducting rounds, residents’ rooms, bathrooms, and toilets were clean and did not smell any odors that would indicate that clients urinate or vomit.

Based on observation, statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230531105328

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: 06/05/2023

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

· Allegation: Staff do not provide soap to resident. It is alleged that the facility does not provide soap for the resident to wash hands and resident has to buy own soap. Interviews conducted with staff members indicated that the facility provides soap, hand soap, toilet paper and other basic hygiene supplies to the residents. Staff members indicated that if residents run out of soap, or those who consume more than normal, residents can come to the office and the items will be provided to them at no extra charge. Interviews conducted with residents indicated that the facility provide soap although some residents prefer to buy their own soap. Residents interviewed also indicated that when the housekeepers clean their bathrooms, they replenish their toilet supplies including soap. Residents stated that they don’t have any issues with the basic hygiene supplies because it is available to them when they request it from the staff. LPA observed the presence of hand soaps and bar soaps in the residents’ bathrooms. LPA also observed sufficient basic hygiene supplies stored in the facility’s office. Staff interviews, resident interviews and LPA's observation do not corroborate this allegation.

· Allegation: Staff allow residents to smoke in non-designated areas. It is alleged that residents are smoking cigarettes right outside the front door and as a result, the cigarette smoke comes inside the facility and the resident can smell it inside. Interviews conducted with staff members indicated that the facility has a designated smoking area which is located in the back patio. Staff members stated that residents who smoke are aware of the smoking area. Administrator denied the allegation and stated that the house rules indicated that smoking is not allowed in their rooms or other areas other than the designated smoking patio area. Interviews conducted with residents indicated that they are aware of the designated smoking area in the back of the facility. Residents interviewed did not see anyone smoking in the front door and they do not smell smoke inside their rooms. LPA did not observe residents smoking in the front door during the visit. LPA observed residents smoking in the back patio area (photos taken). Staff interviews, resident interviews and reviewed documentation do not corroborate this allegation.

Based on observation, statements and interviews conducted with staff, residents, review of facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided to the 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: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3