191592947-9-29-2022-28-AS-RORN-CK4L3C-20221011082340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 09/29/2022
Date Signed: 09/29/2022 09:56:06 AM

Unsubstantiated

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
08/23/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220823114418

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: 58	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Administrator Carmen Galicia		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff will not take resident to the doctor
Staff are not following physician's orders
Staff are not washing residents clothes/sheets properly

INVESTIGATION FINDINGS:

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On 9/29/2022 at 9:00 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the allegations listed above. LPA met with Administrator Carmen Galicia and explained the reason for the visit. The initial complaint visit was conducted on 8/30/2022.

The investigation consisted of the following: During the initial visit, LPA toured the facility with the administrator and obtained the resident/ staff roster, R1's discharge paperwork dated 7/25/22, 8/19/22, 8/24/22, and 8/26/22. LPA received a copy of Incident reports dated 7/25/22, 8/1/22, and 8/19/2022, Pest control reports dated 8/10/22 and 8/17/2022, Laundry schedule, list of R1’s medications, and a copy of R1's MAR. LPA interviewed residents R1 through R6. LPA Interviewed administrator and staff S1. During the subsequent complaint, LPA received written notice from R1's primary care provider confirming that R1 is negative for scabies.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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-20220823114418

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: 09/29/2022

NARRATIVE

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The investigation revealed the following: regarding “Staff will not take the resident to the doctor”, it was alleged that the facility would not send R1 to the doctor. R1 was admitted into the facility on 7/20/22. R1 was sent to the hospital on 7/25/22, 8/1/22, and 8/19/22. The facility sent SIRs via fax to Licensing office for all of R1’s hospital visits. LPA interviewed the administrator and confirmed that R1 was sent to the hospital upon request. S1 confirmed that the facility sends residents to the hospital when they request it or when there is a change in the residents’ condition. 5/6 residents confirmed that the facility have sent residents to the hospital when needed. R1 confirmed seeing a doctor since the complaint.

The investigation revealed the following: regarding “Staff is not following physician’s orders”, it was alleged that R1 was prescribed scabies cream and staff is not putting it all over the body as directed. LPA reviewed R1's MAR and confirmed R1 was prescribed permethrin for history of parasitic disease. The facility administered the medication on 8/25/22 per R1’s MAR. The administrator stated the cream was not for scabies and was prescribed to R1 because R1 complained of bed bugs. The administrator also stated that the resident never complained of scabies. Staff 1 indicated the medication was a one-time use and was given as prescribed. 5/6 residents stated they have always received their medications from the facility with no problems. LPA also reviewed discharged paperwork from Kaiser dated 8/24/22 and confirmed a scabies test was not performed on R1. The primary care provider for R1 issued a letter to the facility confirming that R1 does not have scabies.

The investigation revealed the following: regarding “Staff is not washing residents’ clothes/sheets properly”, it is alleged that the facility is not washing R1’s clothes properly to clear scabies. R1's primary care provider stated that R1 does not have scabies. The administrator stated that R1's bedroom has bed bugs and is currently being treated. 5/6 residents stated that staff wash their clothes once a week without any issues. 1/6 of the residents stated that the facility should follow a certain procedure while washing residents' clothes to remove scabies. For the bed bugs allegation please refer to complaint # 28-AS-20220912122555 dated 9/12/22.

Based on LPA's interviews, and file review the investigation revealed: 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 conducted with Carmen Galicia and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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