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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005199
Report Date: 06/02/2021
Date Signed: 06/02/2021 02:54:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:COTTAGES AT ARTESIA GARDENS, THEFACILITY NUMBER:
306005199
ADMINISTRATOR:CAMILLE CRENSHAWFACILITY TYPE:
740
ADDRESS:6041 KINGMAN AVETELEPHONE:
(800) 570-2273
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:55CENSUS: DATE:
06/02/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Diluvan HassanTIME COMPLETED:
02:35 PM
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An informal virtual meeting was held on Microsoft teams due to Covid 19 restrictions and precautions at Orange County Adult and Senior Care Regional Office in Orange. The informal meeting process was explained to Licensees.

Present during the meeting were Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Analyst (LPA) Kimberly Lyman, Prospective Licensee Diluvan Hassan and Consultant Lorenzi Munez. Current Licensee Gary Langandoen was present via phone. The purpose of today's virtual Informal meeting was to discuss the transition from current to prospective licensee.

The following items were discussed with Current/ Prospective Licensees:
  • Current Licensee maintains ownership and a functioning part of the facility until new license is granted.
  • Lease back agreement is to be in place and a copy forwarded to LPA by 06/09/2021.
  • Designation of new Administrator and pertinent documentation to be forwarded to LPA by 06/09/2021.
  • Change of management application to be submitted to Central Application Bureau.


Prospective Licensee stated that a change of management application has been submitted to Central Applications Bureau.

Both parties involved acknowledged understanding of the process to transition the facility to the new license.

A copy of this report was provided to Licensee via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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