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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 05:55:27 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
09/06/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20230906145516
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: DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Christian Otbo - Executive Director TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are mishandling the residents' level of care assessments.
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 the complaint on 09/06/2023 and LPA Mendivil conducted the initial 10 day visit on 09/12/2023. LPA Mendivil interviewed staff and obtained copies of blank assessments. Regarding the allegation that staff are mishandling the resident's level of care assessments, the investigation revealed the following:

It was alleged faciltiy is mishandling resident's level of care assessments. Based on interviews with 2 out of 2 staff on 09/12/2023 both staff stated due issues with internal systems they were not able to update assessments electronically, but were providing all services required for each resident.
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-20230906145516
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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Interview conducted with current Executive Director (ED) Christian stated once a resident has placed a room deposit and completed the LIC 602 Physician's Report the facility will set up an appointment to conduct the assessment. ED stated will conduct assessment with resident and family and ensure everyone is aware of the level of care that was assessed. Interviews with staff that assist with Assisted Living care assessments stated the residents are involved and can ask for their care plans.

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 records reviewed and interviews the allegation staff are mishandling the residents' level of care assessments 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.
No deficiencies cited.

An exit interview was conducted and a copy of this report 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