191592947-6-22-2023-28-AS-RORN-CU4KUB-20230726081228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 06/22/2023
Date Signed: 06/22/2023 02:42:57 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
06/13/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230613104451

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: 61	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Khrysta Margaros, Assistant Administrator		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff spoke inappropriately to resident in care.
Staff is trying to force resident to sign unknown documents.
Staff do not provide room cleaning services to resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted the complaint investigation for the allegations listed above. LPA arrived unannounced and met with Assistant Administrator, Khrysta Margaros. The purpose for the visit was explained. Administrator, Gemma Deoso, arrived shortly thereafter to assist with the visit.

The investigation consisted of the following:
LPA obtained copies of the staff and resident rosters, staff in-service training log, and reviewed Resident's #1 (R-1) file. LPA also toured the facility, interviewed the Administrator, Staff #1 - #4, and Residents #1 - #6.

The investigation revealed the following:
For allegation - Staff spoke inappropriately to resident in care. During the visit today, LPA interviewed the Administrator, Staff, and Residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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-20230613104451

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: 06/22/2023

NARRATIVE

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The administrator and staff denied speaking inappropriately or being rude to residents. Some stated that the residents could misconstrue staff when they are being firm or talking a bit louder due to hearing impairment. Staff indicated they receive training on how to communicate effectively with the residents. 5 out of the 6 residents did not encounter staff being rude or speaking to them inappropriately. They said staff are respectful and one mentioned that the residents are the ones that are rude or yelling at staff. One resident felt that staff are being rude when they ignore the resident's request because they are in a hurry to do something else.

For allegation, Staff is trying to force resident to sign unknown documents. The administrator and assistant administrator denied forcing residents to sign documents and stated they always explain to residents what they are signing. They would present the document(s) to the resident and go over each item before they have them sign. For residents in the Assisted Living Waiver (ALW) program, they would request for a social worker from the ALW agency to explain the forms that the residents are signing. 5 out of the 6 residents have not been forced to sign documents they were not aware of. They stated the administrator will explain the forms before requesting for a signature. One of the residents stated the administrator did not disclose all the forms that were signed.

For allegation, Staff do not provide room cleaning services to resident in care. Administrator and Staff stated the residents' rooms are being cleaned daily. They stated the rooms get mopped, trash thrown out, and toilets cleaned every day. They also deep clean the rooms once a week. 5 out of the 6 residents stated that staff clean their rooms daily or several times a week. They are satisfied with the cleaning services and have no concerns. One resident stated that staff did not respond to the request to clean the bathroom wall and is still dirty. During the visit, LPA observe staff mopping the floors and cleaning the rooms. LPA did not see any bathroom walls dirty.

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 with the Administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC9099 (FAS) - (06/04)

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