191592947-6-13-2023-28-AS-TVAO-CTUTND-20230718145230

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 06/13/2023
Date Signed: 06/13/2023 12:53:50 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
06/05/2023 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20230605141305

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: 60	DATE:	06/13/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gemma Deoso - Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not prevent resident from stealing another resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced initial complaint investigation visit regarding the above allegation. LPA met with Gemma Deoso Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff/resident roster, face sheet, physician's report, preplacement appraisal information, resident personal property and valuables, for resident #1 (R1) and #2(R2). LPA interview residents 1 - 5 and staff 1-5.

The investigation revealed the following: Regarding allegation: Staff did not prevent resident from stealing another resident's personal belongings. It is alleged R2 is continuously stealing R1's personal items; such as phone, debit card, and clothing. R1 stated a phone was stolen from her by R2 and charges to R1's debit card were made for amounts R1 usually does not make. In addition, personal documents have gone missing. Per R1 there was no police report file regarding missing items. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
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-20230605141305

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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Interviews with residents revealed, 4 out of 5 residents interviewed have not experienced losing items while in care at the facility within the last six months. Interviews with staff, revealed 4 out of 5 staff stated R1 has reported missing items. However, staff has assisted resident with searching for items and items were found.1 out of 5 staff stated not to be familiar with any resident reporting missing items. LPA contacted R1's responsible party who stated there was a unknown charge made to the debit card in Utah but was not aware of other charges. Document review revealed, facility has not filed a police report as reported items by R1 had been found. No documents to corroborate the charges to R1's debit card, or ownership of missing items were provided. Due to lack of documentation LPA is not able to determined missing items and/or charges to the debit card.

Based on interviews, the preponderance of evidence standard has been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Gemma Deoso Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
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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