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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592947
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:20:56 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
02/09/2024 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240209085941
FACILITY NAME:WOODRUFF CARE HOME INCFACILITY NUMBER:
191592947
ADMINISTRATOR:GEMMA DEOSOFACILITY TYPE:
740
ADDRESS:16409 WOODRUFF AVENUETELEPHONE:
(562) 925-6581
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:88CENSUS: 77DATE:
02/13/2024
UNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Khrysta Margaros - Assistant AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff disposed of resident's personal belongings.
Staff did not keep facility free of bed bugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint visit to investigate the
above allegations. LPA met with Khyrysta Margaros, Assistant Administrator and explained the purpose of the visit. Administrator, Gemma Deoso is out of the facility today.

The investigation consisted of the following: LPA obtained a copy of the Staff roster, Resident roster, Professional Exterminator inspection reports & Invoices (October 2023-Feb 2024), Notification memo to residents regarding treatment of bed bugs (dated 10/24/2023) and R1 Acknowledgement of Room Safety Inspection (signed by R1 on 08/27/2021). LPA also conducted a facility tour, inspected random residents rooms (Room #s:123, 126, 240, 241, 242 and 243) and interviewed Staff #1 (S1) – Staff #5 (S5), Resident #1 (R1) – Resident #10 (R10).

In regards to the allegation: “Staff disposed of resident's personal belongings.” It was reported that the staff throws away something special of resident’s belongings like brand new clothes, hats, love doll, and new lounge chair due to the facility having bed bugs. Interviewed staff stated that R1 understood and ****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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-20240209085941
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: 02/13/2024
NARRATIVE
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gave the staff permission to throw away some of his belongings due to bed bugs. Interviewed staff indicated that R1 and Administrator agreed to have some of R1's personal belongings discarded to avoid the spread of bed bugs. Staff interviews revealed that staff are not entering residents’ rooms and disposing of residents’ personal belongings without their permission. Staff interviews revealed that staff have not received any complaints regarding this matter. Resident interviews revealed that staff are not entering residents’ rooms and disposing of residents’ personal belongings without their permission. Resident interviews revealed that they have not heard anyone complaining about this matter. Residents and staff interviews do not corroborate this allegation.

In regards to the allegation: “Staff did not keep facility free of bed bugs.", it is alleged that on 02/07/24, and 02/08/24, the staff started spraying for bed bugs. No other details provided. During the visit, LPA toured the common areas of the facility and inspected random residents’ bedrooms (Room #s: 123, 126, 240, 241, 242 and 243). LPA did not observe any bed bugs in the inspected rooms. S1 stated that they are aware of the presence of bed bugs in some rooms and for this reason, the Administrator, contacted a professional exterminator for inspection, prevention, and treatment. Interviews conducted with staff members revealed that inspection, preventive spraying, and treatment are done every month, sometimes 2x a month on a regular basis. S1 provided LPA with pest control inspection reports and invoices for the last 4 months (Oct. 2023 - Feb 2024), as well as a plan of treatment for February 2024. 3 out of the 10 residents interviewed indicated that they have seen a few insects and bugs in the facility, however they do not consider it to be an issue. LPA also reviewed an incident report dated 02/02/2024 regarding discovery of bed bugs to which immediate action was taken by the facility. Therefore, there was insufficient evidence to corroborate this allegation.

Based on statements and interviews conducted with staff, residents, and review of facility file records, 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 to Khrysta Margaros, Assistant Administrator.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC9099 (FAS) - (06/04)
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