306005960-9-29-2023-22-AS-AORZ-CWNTNP-20231016145303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005960
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:45:00 PM

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
08/25/2023 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20230825114411

FACILITY NAME:	WOODBRIDGE TERRACE		FACILITY NUMBER:	306005960
ADMINISTRATOR:	MYRA LOZADA ARAGONES		FACILITY TYPE:	740
ADDRESS:	1 WITHERSPOON		TELEPHONE:	(949) 654-8500
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY:	180	CENSUS: 135	DATE:	09/29/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Susie Mora - Memory Care Director		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Memory Care Director Susie Mora and explained the reason for the visit.

The department received a complaint on 08/25/2023 and the initial 10 day visit was conducted on 08/31/2023 by LPA Mendivil. During the visit on 08/31/2023 LPA Mendivil obtained copies of pertinent documents including needs and services plan, physician’s report, and behavioral assessment. Regarding the allegation staff handled resident in a rough manner, the investigation revealed the following:

It was reported by a witness that Resident 1 (R1) was observed with bruises on hip and thighs while they were being assessed for a new facility. Based on R1’s physician report dated 02/20/2023 it was noted that R1 does not require continuous bed care and is able to ambulate with a walker. CONT on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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-20230825114411

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: 09/29/2023

NARRATIVE

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Based on interviews with 6 out of 6 staff indicated they did not handle R1 in a rough manner. 6 out of 6 staff stated R1 would become combative which results in them backing away. Review of 6 out of 6 staff file indicate staff have trained on Dementia and challenging behaviors. Per interviews with 3 out of 3 residents indicate the staff is not rough with them when assisting with activities of daily living. LPA Mendivil attempted to interview R1 at their current facility but R1 would not respond to LPA Mendivil's questions.

Therefore based on evidence through records reviewed and interviews the allegation Staff handled resident in a rough manner is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report and confidential names list was provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

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