306005960-12-15-2022-22-AS-SSAS-CM9C3Z-20221219003509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005960
Report Date: 12/15/2022
Date Signed: 12/15/2022 11:22:03 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, 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
10/28/2021 and conducted by Evaluator Kathrina Chin

COMPLAINT CONTROL NUMBER: 22-AS-20211028084957

FACILITY NAME:	WOODBRIDGE TERRACE		FACILITY NUMBER:	306005960
ADMINISTRATOR:	PRATT, STEPHEN		FACILITY TYPE:	740
ADDRESS:	1 WITHERSPOON		TELEPHONE:	(949) 654-8500
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY:	180	CENSUS: 117	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Terrie Sherrell, Assisted Living Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Allegation 1- Staff caused bruising to resident.
Allegation 2 – Staff are not properly transferring resident.
Allegation 3- Resident was left on the floor for an extended period of time.
Allegation 4- Resident was left in soiled clothing for period of time.
Allegation 5- Staff did not seek and address resident medical condition in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA Chin met Myra Aragones, Executive Director and Terrie Sherrell, Assisted Living Director.

During the investigation of the above allegations, the Department interviewed staff, witnesses as well as reviewed and obtained pertinent records.

The investigation revealed that resident (R1) was admitted to the facility on October 7, 2021 and resided in the Memory Care Unit. Resident had Alzheimer’s per the Physician’s Report dated September 29, 2021. Resident is 96 years old and receiving home health services as well as physical therapy services.
On October 27, 2021, resident fell and was found on the floor. Staff 1 (S1) was interviewed and he reported that he was the first staff to find the resident on the floor. S1 said that he called the Staff 2 (S2) who is a Medication Technician who came to the room immediately. Staff 2 called 911 emergency personnel.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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 22-AS-20211028084957

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WOODBRIDGE TERRACE	FACILITY NUMBER: 306005960
	VISIT DATE: 12/15/2022

NARRATIVE

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LPA interviewed R1’s responsible party who stated that R1 falls quite often and requires transferring from her bed to her wheelchair all the time. R1’s responsible party stated that R1 always had a lot of bruises and was declining quickly. R1 was placed on hospice care on December 2021 due to the rapid decline in health. Also, resident was receiving physical therapy twice a week upon admission for balance and being a fall risk.

S1 who reported that three staff members lifted when R1 fell on October 27, 2021. S1 stated that resident was found between 6:30 AM and 7:00 AM with her back facing up. The Administrator stated that the final check that morning was between 5:20 AM and 5:45 AM. S1 stated that R1 is checked every two hours for safety checks. S1 also added that all staff are trained to properly transfer residents. S2, Medication Technician, stated that she dialed 911 emergency personnel immediately after she came to R1’s room and saw her on the floor. R1’s first fall was on October 27, 2021 and was returned to the facility the same day. R1 was returned to the community with a Urinary Tract Infection and was prescribed antibiotics.

S3 who is the former, Wellness Director/LVN stated that resident was reported by staff to have their leg hanging off the bed often. R1 who has dementia also takes off their diapers often and feces might have gotten into their nails. S3 reported that the hoyer lift was delivered to the facility on 10/13/2021. S3 also stated that 911 emergency personnel was called for R1 for shortness of breath on October 12, 2021 and October 22, 2021.

Based on the information gathered during the investigation and review of all documents obtained, the following allegations: Staff caused bruising to resident, Staff are not properly transferring resident, Resident was left on the floor for an extended period of time, resident was left in soiled clothing for an extended period of time, staff did not seek or address residents medical condition in a timely manner are deemed Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report was provided during the visit to Terrie Sherrell, Assisted Living Director.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC9099 (FAS) - (06/04)

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