191592947-9-16-2021-28-AS-LHIS-C7GV38-20211004160415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 09/16/2021
Date Signed: 09/16/2021 01:27:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/10/2021 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210910160143

FACILITY NAME:	WOODRUFF CARE HOME INC		FACILITY NUMBER:	191592947
ADMINISTRATOR:	SANCHEZ, CHANEL		FACILITY TYPE:	740
ADDRESS:	16409 WOODRUFF AVENUE		TELEPHONE:	(562) 925-6581
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	88	CENSUS: 69	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Chanel Sanchez, Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff threw away resident’s belongings without permission.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit to investigate the above allegation. The purpose of the visit was discussed with Administrator Chanel Sanchez.

The investigation consisted of the following: A physical plant tour of the interior and exterior physical plant was conducted. LPA observed Resident (R1's) room. Staff (S1-S4) and Residents (R1- R10) were interviewed. R1's file documents were reviewed and obtained: [Identification and Emergency Information, Admission Agreement, Client/Resident Personal Property and Valuables, Additional Valuables Inventory List, Bed bug policy, House Rules, Resident Acknowledgement of Room Safety Inspection, Bed Bug procedures, LIC 500 Personnel Report, resident roster, and pest control service contract-in-voice. RTC Pest Control company was present during the visit treating a total of 5 rooms and common areas for cockroaches. Pictures of R1's room belongings during the clean-up and furniture removal were reviewed. Two (2) pictures were obtained.

**** See LIC 9099C for continuation of report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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-20210910160143

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WOODRUFF CARE HOME INC	FACILITY NUMBER: 191592947
	VISIT DATE: 09/16/2021

NARRATIVE

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Allegation: "Staff threw away resident’s belongings without permission." Based on record review and interviews conducted, on September 7, 2021 facility staff went into resident's rooms to remove furniture and personal belongings that were infested with cockroaches. A previous complaint dated 8/16/21 addressing cockroaches in the facility was substantiated. As a result facility Administrator and staff inspected rooms that had cockroaches and bed bugs and discarded infested furniture. Resident (R1) was out of the facility when staff went into the room to clean it and threw away an alleged new rocking chair. Per observation, the rocking chair has not been replaced. Administrator stated that if R1 provides a receipt of R1's alleged "new" rocking chair that was thrown away the facility will purchase a replacement chair. Residents interviewed confirmed some of their belongings and furniture were thrown away because they had a lot of cockroaches. Four (4) out of 10 residents stated their furniture and personal belongings were thrown away without permission due to cockroaches in their room. However, the facility gave notification of clean-up and removal of furniture [if needed] on August 25, 2021 during a resident meeting held outdoors. Facility provided residents a Resident Acknowledgement of Room Safety Inspection form that they signed.

The facility has a pest control contract in place. Pest services are being conducted weekly. As a result, staff remove items prior to pest heat treatment. Any furniture that is infested with cockroaches and bed bugs is discarded into the temporary commercial trash bin outside. Pest services found cockroach infestation and bed bugs in Resident (R1's) room. Nine (9) pictures were obtained. Staff interviewed stated they were instructed to throw away R1's belongings as a remediation plan to the cockroach infestation. During today's visit, LPA observed staff prepping, cleaning, and throwing away items from another resident's room that will be receiving pest services today. Many cockroaches were observed in the furniture that was being thrown away. Per facility Bed Bug Procedure and House Rule protocols state that "personal belongings sanitized or disposed" and "residents will allow staff to dispose of items that are not safe, could cause a pest problem, or could be a fire hazard."

Based upon interviews conducted, record review, and observations made the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Administrator Chanel Sanchez. A copy of the report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210910160143

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WOODRUFF CARE HOME INC	FACILITY NUMBER: 191592947
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/16/2021 Section Cited CCR 1	1 2 3 4 5 6 7	UNSUBSTANTIATED- NO deficiencies cited. Page created in error.	1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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