306005960-4-25-2025-22-AS-AORZ-DGXVPG-20250523163644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005960
Report Date: 04/25/2025
Date Signed: 04/25/2025 08:54:11 AM

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
02/12/2024 and conducted by Evaluator Michael Tea

COMPLAINT CONTROL NUMBER: 22-AS-20240212114038

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: 104	DATE:	04/25/2025
		UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Danna Dsaachs		TIME COMPLETED:	09:08 AM

ALLEGATION(S):

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- Staff did not intervene when visitor caused injury to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Tea made an unannounced complaint visit on this day to deliver findings for the allegation mentioned above. LPA met with Woodbridge Staff Danna Dsaachs.

It was alleged that staff did not intervene when visitor caused injury to the resident. During the investigation LPA interviewed Resident 1 (R1), staff, and witnesses; checked R1’s files; and reviewed R1’s physician report, needs and services plan, identification form and incident reports from the last 3 months of R1. The investigation determined the following:

During the investigation LPA asked R1 if their spouse ever hurt them before, R1 denied their spouse hurt them despite being impatient. When asked about the staff at Woodbridge Terrace, R1 replied they were very helpful, great, and provided the care and supervision they needed. Despite R1’s diagnoses and physical limitations, R1 tries to do things independently without any assistance. Witnesses and staff

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025

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-20240212114038

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: 04/25/2025

NARRATIVE

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interviewed during the investigation all agreed that R1 is a bit stubborn and oppositional creating some minor friction between R1 and their spouse.

Since the alleged incident occurred, Executive Director (ED) Christian Otbo explained the staff have been monitoring R1 and their spouse. The Irvine Police Department (PD) were contacted right away by the facility when the alleged incident was first reported to facility management staff, acknowledging how serious they took the situation. Irvine PD talked to R1 and their spouse and let the facility know nothing criminal occurred after their investigation, concluding there are no indications the spouse intentionally harms R1 and the fact the complaint of pain could be due to a prior rotator cuff injury.

Based on the police report LPA obtained from Irvine PD, the facility always had personnel/caregivers typically stayed around the couple when they were together prior to the incident occurring. In the police report, the investigator also reported the facility placed enough safeguards to deter further harm toward R1 afterwards, in which a caregiver is always present with them when R1’s spouse visits. The police investigator noted in the report the facility continually follows up and document’s R1’s shoulder pain. 3 out of 3 facility staff interviewed indicated that the facility did keep a close eye on R1 and their spouse after the incident. Assisted Living Director (ALD) Rose Alcantara explained that the pair have supervised visits at the facility bistro and library where generally there are a lot of people and staff present. If they go to R1’s room a caregiver is always present with them to ensure safety measures for R1. ALD Alcantara also mentioned the facility did safety checks, checked up on R1 every hour and did a medical assessment, where x-rays indicated no evidence of a fracture or injury.

Therefore, based on LPA Tea's observation and interviews conducted and records review the allegation the staff did not intervene when visitor caused injury to resident has been determined to be unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies cited at this time and an exit interview was conducted and a copy of the report and confidential names list was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025

LIC9099 (FAS) - (06/04)

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