Woodbridge Terrace.

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received an Unusual Incident/Injury Report on 01/06/2026 for an incident that occurred with Resident 1 (R1) on 12/27/2025. While at the facility LPA Mendivil requested copies of admission agreement, medication administration records for R1, care notes , physician's report and staff schedule to be emailed to LPA by COB 01/06/2026. LPA toured common areas of the facility. LPA observed Assisted Living residents participating in chair volleyball and Memory Care residents were in the common area watching a movie. LPA did not observe any immediate health and safety concerns during today’s visit. No deficiencies cited at this time. An exit interview was conducted and a copy of this report was provided.

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver case management findings. LPA was greeted and granted entry and explained the reason for the visit. The Department received an Unusual Incident/Serious Injury Report on September 12, 2025, for an incident that occurred on September 10, 2025, with Resident 1 (R1). LPA Mendivil conducted a case management visit on September 16, 2025, and gathered admission agreement, medication administration records for R1, care notes and staff schedule. The course of the investigation revealed the following: R1 was admitted to the facility on January 12, 2025. Per review of R1’s level of care effective on August 31, 2025, stated R1 is a fall risk and staff were to provide safety checks and remind R1 to use their walker when ambulating. R1 has a diagnosis of senile dementia, hypertension and falls based on R1’s physicians report dated January 11, 2025. On September 10, 2025, around 6:30pm, R1 had an unwitnessed fall in the Memory Care common tv room. Staff 1 (S1) reported they were assisting another resident that pressed the egress door at the time of the fall, approximately 20 feet away from R1. When S1 came back into the living room area they observed R1 to be on the floor next to the recliner they were previously sitting on. It was reported that S1 asked for assistance from other staff to assess R1. R1 was observed to have a small skin tear on elbow and expressed pain upon moving their right leg. It was then reported that the facility called 911 and the resident was taken to the hospital where they were diagnosed with a hip fracture. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Prior to hospitalization, incident reports reviewed showed R1 had six separate falls which resulted did not result in any serious bodily injuries until the fall on September 10, 2025. Based on interviews with Executive Director Christian, it was reported that R1 had 2 assessments one at admission and once again in August of 2025. Per review of incident reports for falls on January 28, 2025; March 17,2025; March 25, 2025; April 16, 2025; May 14, 2025; May 18, 2025; July 07, 2025; August 02, 2025; and September 10, 2025; staff assessed R1 following falls. In addition, R1’s family and physician were notified. Per interviews with R1’s physician assistant (PA) it was reported R1 had significantly more falls at their previous facility and the PA stated they did not feel facility staff were neglectful or provided inadequate care for R1. Therefore, based on evidence through records reviewed and interviews, the Department could not corroborate if neglect/lack of care and supervision caused R1’s fall and injuries. No deficiencies are being cited. An exit interview was conducted, and a copy of this report was provided to Executive Director.

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management visit. LPA was granted entry into the facility by staff and explained the reason for the visit. The Department received an Unusual Incident/Injury Report on 09/12/2025 for an incident that occurred with Resident 1 (R1) on 09/10/2025. LPA Mendivil obtained copies of LIC 602 and Care Plan via email on 09/12/2025. While at the facility LPA Mendivil requested copies of admission agreement, medication administration records for R1, care notes and staff schedule to be emailed to LPA by COB 09/16/2025. LPA toured common areas of the facility. LPA observed Assisted Living residents participating in chair volleyball and Memory Care residents were in the common area watching a movie. LPA did not observe any immediate health and safety concerns during today’s visit. No deficiencies cited at this time. An exit interview was conducted and a copy of this report was provided.

On this day, Licensing Program Analysts (LPAs) Andrea Mendivil and Fred Arias made an unannounced visit to conduct a required annual. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During today’s visit, LPA Mendivil along with Daisy Gonzales, Hospitality Service Director toured the facility and inspected the physical plant, including but not limited to testing hot water temperatur e in six bathrooms. The hot water temperature measured between 115 and 120 degrees Fahrenheit. The facility’s last fire drill was conducted on Ma y 15th, 2025 . LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA Arias observed medication storage and reviewed the centrally stored medications for three residents . Per review completed medication appear to be being given as prescribed. LPA Men divil observed activities in the form of group exercise, hair salon and gym. LPA Arias reviewed six out of six staff records. LPA Arias conducted a complete review of seven resident records. LPA Mendivil confirmed that administrator has a current administrator certificate which expires on 02/09 /2026 Based on the observations made during today’s visit no deficiencies cited on this date. An exit interview was conducted with facility staff and copy of this report was provided.

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.

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.

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today's visit was to conduct a case management. LPA Tea was greeted and granted entry into the facility by Executive Director (ED) Christian Otbo. On this day LPA Tea amended LIC9099 dated 01/16/2025. LPA reviewed amended report with executive director. An exit interview was conducted with the ED Otbo. A copy of this report and amended LIC9099 was provided to the facility.

(continued from LIC9099) On 11/5/2024 LPAs conducted a visit to the facility. LPAs obtained copies of the personnel report, resident roster, physician's reports and physician's orders. LPAs toured the facility, interviewed staff, made observations of resident rooms and reviewed records. LPAs observed 4 residents (R1, R2, R3, R4). It was reported that R1 is bedridden. Based on record review, it was found that R1 is non-ambulatory. R2, R3 and R4 were observed with hoyer lifts in their rooms. LPAs reviewed current physician's orders for hoyer lifts for R2, R3 and R4. Based on records reviewed and observations made, LPAs determined that the facility is not accepting bedridden residents. Based on records reviewed and observations made, LPAs determined that the facility is adhering to physician reports. Based on LPAs' observations and review of documents obtained, these allegations are UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required One Year visit to ensure substantial compliance with Title 22 regulations. According to the facility’s license, the facility has a maximum capacity of 180 non-ambulatory clients ages 60 and over, of which 140 may be non-ambulatory. Facility also has a hospice waiver for 20. LPA was granted entry into the facility and was met by Executive Director (ED) Christian Otbo whom LPA discussed the purpose of the visit. LPA was accompanied by ED Otbo, during a tour of the facility, which was conducted inside and out including a sample of resident units, the dining area, recreation rooms, outside grounds, and food storage areas.. Exterior and interior passageways were free from obstructions. Pathways were free of obstruction and slip hazards. Smoke and carbon monoxide alarms are hard wired to a central location. All doors and elevators were operational. Emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Each resident had clean and sufficient bed linens. Linens are kept in the individual rooms and extra linens towels, and washcloths are kept at facility in store room. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. [CONTINUED ON LIC 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [CONTINUED FROM LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. The food service area was observed to be neat a nd clean. Food menus and activities schedule were posted and also available through a monthly community bulletin . C entral cleaning supplies were stored in a locked closed room. Centrally stored medications were properly stored and locked on medication carts. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Staff records review verified that all staff records are complete and compliant. All direct care staff have First Aide/CPR certificates, and staff training. Resident records reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPA conducted a thorough review of In-service training procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted, this report was discussed with ED Otbo. The report along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to Executive Director,Otbo.

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.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an incident report received by the department on 06/26/2024. LPA was greeted and granted entry by Reception Rosa Leaning and explained the reason for the visit. Executive Director Christian Otbo arrived during the visit. Incident report dated 06/26/2024 indicated Resident 1 (R1) had reported that the resident's private caregiver (PC) had hit the resident. Irvine Police responded, case #24-06954, and determined no criminal activity had occurred. Facility interviewed Resident who changed the story upon interview. Facility interviewed private caregiver who denied the accusation stating that the private caregiver had placed his hand on the resident's neck to guide him to restroom. Facility contacted staffing agency to request the private caregiver not be placed in facility again due to allegation. Per physician report dated 02/09/2024, R1 is diagnosed with Metabolic Encephalopathy and Mild Cognitive Impairment. Physician report indicates resident is confused/ disoriented. LPA is unable to interview resident as resident has moved out of the facility. Exit interview conducted and a copy of this report was left at the facility.

Susie stated they did an medication audit and were able to determine the medications were not missed but refused by residents and not properly documented by staff. Susie stated that staff has been retrained on medication refusal and how to properly document. Susie reported the physicians' of the residents were notified and no residents had adverse reactions. During the visit LPA Mendivil observed a locked medication cart in Memory Care and a secured medication room. LPA observed a cabinet above med-tech desk which is not locked but contains paperwork and is secured by either a med-tech present or a locked door when staff is not in the room. Based on interviews with 1 out of 1 staff indicate they received updated training on how to mark refusals in their system and denied residents missing medications due to their errors. Based on interviews with 3 out of 4 residents indicated they receive their medications without issue and are able to refuse medications if they want. The 4th resident stated that they did not receive medications. Therefore, based on evidence through records reviewed and interviews the allegations Facility did not ensure residents receive their medications and Facility did not secure medication from residents in care 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. This agency has investigated this complaint. No deficiencies cited. An exit interview was conducted and a copy of this report was provided.