191592947-10-23-2025-28-AS-DSIS-DMUVNV-20251027163546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:22:36 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
10/20/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251020162944

FACILITY NAME:	WOODRUFF CARE HOME INC		FACILITY NUMBER:	191592947
ADMINISTRATOR:	GEMMA DEOSO		FACILITY TYPE:	740
ADDRESS:	16409 WOODRUFF AVENUE		TELEPHONE:	(562) 925-6581
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	88	CENSUS: 87	DATE:	10/23/2025
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Khrysta Margaros – Assistant Administrator		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff did not adequately address residents’ inappropriate behaviors.
Staff spoke to resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit regarding the above allegation. LPA met with Khrysta Margaros (Assistant Administrator) and explained the reason for the visit.

The investigation consisted of the following:

LPA obtained copies of the staff/residnet rosters, and conducted interviews with 8 Residents (R1-R8) and 6 Staff (S1-S6).

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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-20251020162944

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: 10/23/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not adequately address residents’ inappropriate behaviors.
It is alleged that R1’s roommate has been threatening and harassing R1 and the staff are not doing anything about it. LPA interviewed 6 staff and each denied the allegation, stating that R1 has been transferred to 6 different rooms with different roommates and each time there have been issues that begin with R1. Interviews with S1 and S2 revealed that there are no single rooms available to accommodate R1 and they have tried to assist R1 the best they can by separating R1 from roommates they don’t get along with. S2 stated that they are working with R1 to try and relocate them to a sister facility and R1 has been interested in this and is doing a tour of the sister facility tomorrow. LPA spoke with R1 and it was confirmed that staff are trying to assist them and will be touring the sister facility tomorrow. LPA interviewed R1’s current roommate R2 and R2 denied the allegation and stated that they are not harassing R1 and have never threatened R1 but agreed that the 2 do not get along well, R2 stated staff have spoken to them about the house rules and getting along with residents and has agreed to not engage in arguments with R1. LPA interviewed a total of 8 residents and 7 out of 8 residents denied the allegation, interviews with R2,R4 and R5 revealed that they have had altercations with R1, however, staff intervened, have addressed the issues and things appear to have progressed.

Allegation: Staff spoke to resident in an inappropriate manner.
It is alleged that S1 yelled at R1 when R1 was trying to explain to S1 what was happening with their new roommate. LPA interviewed 6 staff and each denied the allegation stating that they have never yelled at any of the residents or seen another staff yell at any residents. S1 stated that they did not yell at R1 but do recall having a conversation with R1 in which R1 had their TV on loudly and refused to turn it down causing S1 to speak loudly but they denied ever yelling at the resident. LPA interviewed 8 residents and 7 out of 8 residents denied the allegation stating that they have never been yelled at by staff and have never witnessed staff yelling at other residents.

Based on statements and interviews conducted with staff and residents, 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. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

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