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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005960
Report Date: 01/24/2022
Date Signed: 01/28/2022 03:04:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:WOODBRIDGE TERRACEFACILITY NUMBER:
306005960
ADMINISTRATOR:PRATT, STEPHENFACILITY TYPE:
740
ADDRESS:1 WITHERSPOONTELEPHONE:
(949) 654-8500
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:180CENSUS: 103DATE:
01/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Stephen Pratt, Executive DirectorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone and FaceTime as a follow up to a case management- incident due to COVID-19 and for pre-cautionary measures. LPA Chin identified herself and LPA spoke Executive Director, Stephen Pratt regarding a self-reported incident which occurred on January 18, 2022 and an unusual incident report submitted the same day.

On 1/18/2022, two care staff members were found sleeping in the Memory Care Department while caring for eight residents. Mr. Pratt reported that the HR Director and the Memory Care Director conducted a random check at the facility on January 18, 2022 on staff 1 and staff 2 at approximately 4:30 AM and observed both staff members to be sleeping on the job. Both staff members were immediately suspended and are no longer working for the facility. The facility submitted both an unusual incident report and SOC 341 Report of Suspected Dependent Adult/Elder Abuse to the licensing office.

No deficiency cited this review.

An exit interview was conducted with Administrator via telephone and a copy of this report was provided to Administrator via email. Stephen Pratt, ED agreed to confirm the receipt of the document, review the report and return a signed copy.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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