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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005960
Report Date: 07/25/2024
Date Signed: 07/25/2024 06:20:18 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
07/16/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240716153403
FACILITY NAME:WOODBRIDGE TERRACEFACILITY NUMBER:
306005960
ADMINISTRATOR:MYRA LOZADA ARAGONESFACILITY TYPE:
740
ADDRESS:1 WITHERSPOONTELEPHONE:
(949) 654-8500
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:180CENSUS: 132DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Susie MoraTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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9
Staff refused to transport resident for doctors visit.
Staff did not prevent covid outbreak.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Assistant Administrator Susie Mora and explained the reason for the visit. The investigation into the allegation, staff refused to transport resident for doctors visit, revealed the following. It was alleged that Resident 1 (R1) complained about an ongoing cough from July 8, through July 13, 2024, and asked staff to assist them with seeing a doctor about their cough. R1 reported they did have a cough but they did not report to staff that they wanted to see a doctor. 5 out of 5 staff interviewed reported they did not notice R1 coughing or displaying symptoms of Covid-19. It was reported that R1's family requested a Covid-19 test for R1 on July 12, 2024 but staff did not administer a Covid-19 test. 5 out of 5 staff interviewed could not corroborate that report. On July 15, 2024 R1 tested positive for Covid-19. Staff tested R1 for Covid-19 on that day at the family's request. R1's primary care physician was notified and prescribed new medication for R1. A review of facility records and 7 out of 7 witnesses interviewed, verifies this information. None of the evidence gathered supports the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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 2
Control Number 22-AS-20240716153403
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: WOODBRIDGE TERRACE
FACILITY NUMBER: 306005960
VISIT DATE: 07/25/2024
NARRATIVE
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Based on the evidence the allegation, is deemed unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

The investigation into the allegation, staff did not prevent covid outbreak revealed the following. It was alleged that the facility did not follow the infection control plan when a resident had obvious Covid-19 symptoms and when residents tested positive for Covid-19. A review of records shows that 9 residents tested positive for Covid-19 from July 1, 2024 until July 25, 2024. The facility has a census of 132 residents. The Assistant Administrator reported that once a resident is tested positive for Covid-19 they contact Orange County Health Care Agency, Community Care Licensing (CCL), the resident's physician and their responsible party. The Assistant Administrator reported that once a resident is tested positive they self isolate in their room and staff interacting with them follow all the guidelines regarding the use of PPE. It was reported that R1 was exposed to Covid-19 from Resident 2 (R2) and R2 had obvious symptoms of Covid-19. 5 out of 5 staff interviewed could not verify this report. R1 could not verify this report. R2 could not be reached to be interviewed. R2 tested positive for Covid-19 the day after R1 tested positive. It was reported that the facility was slow to act when R1 tested positive for Covid-19. The Assisted Living Director reported that once R1 tested positive they notified the family and the physician and R1 agreed to isolate in their room. All 7 witnesses interviewed and R1 verified this report. It cannot be determined where R1 or R2 caught Covid-19. All 5 staff interviewed and the Assisted Living Director and the Assistant Administrator reported that all residents who tested positive for Covid-19 were isolated and the facility followed their infection control plan. There is no evidence to support the allegation, therefore the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2