191592947-4-3-2025-28-AS-DSIS-DFJTXH-20250408150709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 04/03/2025
Date Signed: 04/03/2025 01:02:48 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
03/24/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250324101322

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: 83	DATE:	04/03/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Gemma Deoso - Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff disposed of resident's personal belongings.

INVESTIGATION FINDINGS:

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

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

The investigation consisted of the following:
On 3/27/25 LPA conducted an initial visit and obtained copies of the staff and client roster and LPA interviewed Administrator.
During todays visit LPA obtained copies of client/staff rosters, copy of Resident #1's (R1's) Resident Inventory Sheet, a tour of storage areas and R1's room was conducted and LPA interviewed 3 staff and 8 residents.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

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 2

Control Number 28-AS-20250324101322

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: 04/03/2025

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 disposed of resident's personal belongings.
It is alleged that staff have thrown away a few R1’s personal belongings such as a drum, paintings, binoculars, shoes, and a box of CDs. LPA reviewed R1’s Resident Inventory Sheet dated 10/28/18 and all items that have allegedly been stolen (except for shoes) were not listed on inventory sheet. LPA toured R1’s room, paintings, drum, and shoes were observed in the room. LPA interviewed R1 and it was stated that the Inventory Sheet was not updated with the mentioned missing items as they were unaware that was offered/needed, R1 stated that their paintings and drum have been returned as they were in storage, however, the other items are still missing. LPA toured the facilities storage sheds and storage room located on the 2^nd floor and observed multiple items that were explained to be stored for residents to create space as their rooms cannot fit large items. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation. S3 stated that although they have seen staff throw items away, they have only observed it to be spoiled food and have never seen personal items being thrown away. LPA interviewed 8 Residents and 6 out of 8 Residents denied the above allegation, although some residents confirmed that some personal items have gone missing, they cannot confirm that it was staff who took them or threw their items away.

Based on statements and interviews conducted with staff/residents, tour or R1's room and LPA's observations, 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, and a copy of this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2