306005199-6-17-2021-22-AS-SSAS-C4UQ78-20210712115444

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005199
Report Date: 06/17/2021
Date Signed: 06/17/2021 10:32:59 AM

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
12/30/2020 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201230141111

FACILITY NAME:	COTTAGES AT ARTESIA GARDENS, THE		FACILITY NUMBER:	306005199
ADMINISTRATOR:	CAMILLE CRENSHAW		FACILITY TYPE:	740
ADDRESS:	6041 KINGMAN AVE		TELEPHONE:	(800) 570-2273
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY:	55	CENSUS: 33	DATE:	06/17/2021
		UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Aurelia Olais, Administrator		TIME COMPLETED:	10:42 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident became severely malnourished while in care
Resident suffered from dehydration while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Jim August made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Administrator Aurelia Olais. The investigation consisted of interviews with the facility staff, Administrator Camille Crenshaw, and witnesses as well as reviewing and obtaining documentation. The following was determined:

On December 30, 2020, the Department received a complaint alleging that the resident became severely malnourished and became dehydrated while in care. It was alleged that Resident #1(R1) lost a significant amount of weight.

During interviews, the Administrator and staff stated they never observed any signs or symptoms of R1 being malnourished. The daily logs from the facility from June 2020 through November 2020 showed when R1 missed or refused a meal. The logs showed that R1 only missed a few meals during this time frame but R1 never went an entire day without eating. CONTINUED ON LIC9099C DATED 6/17/2021...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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 3

Control Number 22-AS-20201230141111

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: COTTAGES AT ARTESIA GARDENS, THE	FACILITY NUMBER: 306005199
	VISIT DATE: 06/17/2021

NARRATIVE

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

The Power of Attorney (POA) for R1 stated that the facility took good care of R1. The POA further stated that R1 did not lose weight while living at the facility but it was expected due to R1’s diagnosis.

The treating physician at Kaiser Hospital was contacted about R1’s malnutrition/dehydration status during his visit on November 30, 2020; however, the physician never returned any phone calls.

The Dietary Clinician who evaluated R1 for malnutrition was interviewed. The Clinician said that they use several different methods to determine if the weight loss is caused by malnourishment or other medical reasons. Some of these methods are labs, food intake history, medical diagnoses and measurement of bone and muscle loss density. The Dietary Clinician did not have any history of R1’s eating habits but she said that he did not eat well during his stay in the hospital. The Dietary Clinician also said that she was unable to conduct muscle/bone density on R1 and other tests due to COVID-19 restrictions. Therefore, she was unable to give an exact answer on whether R1’s weight loss was caused by neglect/malnourishment or other medical factors.

The Dietary Clinician further explained that if R1 was used to a certain diet before entered the facility (fast food), the change in diet and type of food he was served at the facility could be a partial factor in his weight loss. R1’s medical condition such as dementia, stroke and diabetes may be contributing factors to the weight loss.

Several facility staff were interviewed who indicated that R1 was provided beverages with each meal. R1 liked water, juice and soda. Staff stated they observed no signs of R1 being dehydrated.

Medical records from West Anaheim Medical Center and Kaiser Hospital were reviewed. R1 was treated for dehydration during his visit to West Anaheim on November 28, 2020 and his continuing care at Kaiser on November 30, 2020. The records did not indicate the possible cause for the dehydration.

The treating physician at Kaiser Hospital was contacted regarding R1’s dehydration and no return calls were received.

CONTINUED LIC9099C DATED 6/17/2021...

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20201230141111

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: COTTAGES AT ARTESIA GARDENS, THE	FACILITY NUMBER: 306005199
	VISIT DATE: 06/17/2021

NARRATIVE

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

The Dietary Clinician from West Anaheim Medical Center was interviewed. The Dietary Clinician said that R1 came to the hospital on November 28, 2020 with an altered mental state which may have been caused by his COVID-19 diagnosis. The COVID-19 diagnosis and the fact that R1 had an altered mental state may have caused R1 to refuse or consume less fluids. This may have been a factor in his dehydration.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
An exit interview was conducted with Aurelia Olais and a copy of this report was provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3