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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005960
Report Date: 11/13/2025
Date Signed: 11/13/2025 01:22:38 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
08/14/2023 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230814153307
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: 136DATE:
11/13/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Christian Otbo - Executive Director TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff left resident unattended in soaking wet and dirty diapers for extended periods resulting in multiple UTIs
Staff mismanged resident's medication
Faciltiy lacks management oversight
Insufficient staffing to meet residents’ needs
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 and explained the reason for the visit.

The Department received a complaint on 08/14/2023 and the initial 10 day visit was conducted on 08/22/2023 by LPA Tirre. LPA Tirre obtained copies of pertinent documents such as physicians report. LPA Mendivil conducted interviews with staff and residents. Regarding the allegations Staff left resident unattended in soaking wet and dirty diapers for extended periods resulting in multiple UTIs ,Staff mismanged resident's medication, Faciltiy lacks management oversight ,Insufficient staffing to meet residents’ needs the investigation revealed the following:

It was alleged that Resident 1 (R1) was left unattended in soaking wet diapers for extended periods of time. Per review of R1's physician report dated 02/20/2023 R1 was diagnosed with Vascular Dementia.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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-20230814153307
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: 11/13/2025
NARRATIVE
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Per physican report R1 did not have issues with bowel or bladder impairment and was able to care for own toileting needs. Based on care plan from May 2023 resident was not incontinent in either bowel or bladder. R1 was able to ambulate with the use of a walker and was able to communicate their needs. Based on internal chart notes, after R1's hospital stay on 08/14/2023 staff was providing assistance with incontinent care.
It was alleged the facility left resident unattended in soaking wet and dirty diapers for extended periods resulting in multiple UTIs, based on interviews with 4 out of 4 staff stated they do not leave residents in dirty diapers for extended periods. Per interviews staff stated all residents are checked at minimum every two hours unless resident's care plan requires more frequent checks. Interviews with Current Executive Director (ED) Christian Otbo stated that if residents are refusing services such as incontinent care or showers staff will document and reach out to family for assistance. Based on interviews conducted 4 out of 4 staff stated although the residents can be difficult and not want to be changed they will utilize another caregiver in hopes that will ease the resident and allow for the service to be provided.
Per interview with Med-tech stated if residents refuse medications it will be documented and the physician will be notified. Med-tech staff stated once they provide medication to the resident they are trained to remain with residents until medications are taken and will check for cheek pocketing of medications. Per review of R1's medication administration records medications were refused by R1 on multiple occasions in August 2023 and were documented.
Per ED stated they were no complaints about facility management oversight in 2023 or currently. Per interviews with 3 out of 4 staff stated they do not have concerns about management oversight, 1 staff member was not asked about management oversight.
Per interview with ED stated the facility has used staffing agency to fill shifts they could not cover. Interviews with 4 out of 4 staff stated they did not feel they were understaffed. Interviews with 4 out of 4 residents stated their needs are met.
Therefore based on the preponderance of evidence through records reviewed and interviews the allegations Staff left resident unattended in soaking wet and dirty diapers for extended periods resulting in multiple UTIs ,Staff mismanaged resident's medication, Facility lacks management oversight ,Insufficient staffing to meet residents’ needs 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: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2