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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005960
Report Date: 05/29/2025
Date Signed: 05/29/2025 04:43:08 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
10/18/2022 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20221018111730
FACILITY NAME:WOODBRIDGE TERRACEFACILITY NUMBER:
306005960
ADMINISTRATOR:PRATT, STEPHENFACILITY TYPE:
740
ADDRESS:1 WITHERSPOONTELEPHONE:
(949) 654-8500
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:180CENSUS: DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Christian Otbo - Executive Director TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Medication not being administered as prescribed
Staff did not treat resident with dignity and respect
Facility is charging for services not agreed upon admission
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 Executive Director Christian Otbo and explained the reason for the visit.

The Department received a complaint on 10/18/2022 and the initial 10 day visit was conducted on 10/25/2022 by LPA Mendivil. During the initial visit LPA Mendivil obtained copies of pertinent documents such as staff schedule, resident assessments and physician reports. LPA Mendivil also interviewed staff and residents. Regarding the allegations medications not being administered as prescribed, staff did not treat resident with dignity and respect and facility is charging for services not agreed upon admission, the investigation revealed the following:

It was alleged that Resident 1 (R1) had to wait for over 2.5 hours to receive their medication.
CONT on LIC 9099-C dated 05/29/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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-20221018111730
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: 05/29/2025
NARRATIVE
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Based on interviews with 5 out of 5 staff stated residents get their medications as prescribed. Former Executive Director Myra Aragones stated the facility does not withhold resident's medications and notates when resident's refuse medications. Current Executive Director Christian Otbo stated has not heard of any issues with residents receiving their medications as prescribed. Review of R1's medication administration record indicated resident received their medications as prescribed. Interviews with 6 out of 8 residents indicated they receive their medications as prescribed. The remaining 2 residents manage their own medications.

It was alleged that due to R1 waiting for 2.5 hours for their medication staff did not treat resident with dignity and respect following the medication incident. Based on interviews with 6 out of 6 staff stated they treat residents with dignity and respect. Staff stated they are aware and trained on resident's personal rights. Interviews with 8 out of 8 residents stated they are treated with dignity and respect by all staff.

It was alleged the facility is charging for services that were not agreed upon at admissions. Per interview with former Executive Director Myra Aragones stated that the facility can reassess residents based on a change of condition and provide the services currently needed. Myra stated as residents age they may have change in condition so the facility will provide assistance with Activities of Daily Living (ADLs) as needed. Interviews with 8 out of 8 residents stated they cannot specifically remember their care assessments but were present for conversations about their care.

Therefore based on the preponderance of evidence through interviews and records reviewed the allegations medications not being administered as prescribed, staff did not treat resident with dignity and respect and facility is charging for services not agreed upon admission are 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.
No deficiencies cited.

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

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2