<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005521
Report Date: 04/11/2024
Date Signed: 04/11/2024 03:50:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240117112013
FACILITY NAME:WOODBURY HOMESFACILITY NUMBER:
306005521
ADMINISTRATOR:GARCIA, ANNA CFACILITY TYPE:
735
ADDRESS:11601 STEPHANIE LNTELEPHONE:
(714) 458-5992
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:3CENSUS: 3DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Anna Garcia-AdministratorTIME COMPLETED:
04:06 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff allowed resident to wander from the facility
Staff are not meeting residents needs
Staff do not have personal accommodations
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on 01/17/24. LPA was greeted and granted entry into the facility and met with Administrator (AD) Anna Garcia. LPA explained the reason for the visit.

This agency has investigated the complaint alleging that staff allowed resident to wander from the facility. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Two of four individuals interviewed denied the allegations. During the investigation LPA reviewed documents including the Physician Reports (LIC602s) dated 02/19/23 for Client 1 (C1), C2 and C3. Per Physician Reports C1, C2 and C3 are not able to leave the facility unassisted. During the course of the interviews with staff, Staff 1 (S1) reported that no client has wander from the facility. During the interviews, AD stated that no client has left the facility alone.

CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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 4
Control Number 22-AS-20240117112013
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WOODBURY HOMES
FACILITY NUMBER: 306005521
VISIT DATE: 04/11/2024
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
Regarding the allegation that staff are not meeting residents’ needs, the investigation revealed the following: Documents reviewed by LPA included the Personnel Report (LIC500) dated 01/01/24. Per Personnel Report on average there are two caregivers for the morning and evening shifts from Monday-Friday and one caregiver for the night and weekend shifts. During the initial visit on 01/26/24 and today's visit LPA observed two caregivers on duty for three clients in care. During the initial visit and today’s visit LPA observed as the caregivers checked on the clients at least every 15 minutes, offered them a snack and/or as they were doing exercise such as push-ups.

Regarding the allegation that staff do not have personal accommodations, the investigation revealed the following: During the course of the interviews with staff, S1 reported that staff have a private bedroom to watch television and take breaks. During the course of the interviews, AD stated that the caregivers have a private bedroom for personal accommodations. During the initial visit LPA observed a staff area which is used for staff breaks and for staff to relax.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with AD Garcia, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4