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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005199
Report Date: 06/24/2021
Date Signed: 06/24/2021 12:53:04 PM



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
01/19/2021 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20210119165620
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: 33DATE:
06/24/2021
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Aurelia Olais and Diluvan HassanTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Inadequate staffing to meet the needs of resident's.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA identified herself and discussed the purpose of the visit with Administrator Aurelia Olais. Prospective Licensee Diluvan Hassan arrived during the visit.

During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as staff schedules. Regarding the allegation that inadequate staffing to meet the needs of residents, the investigation revealed the following: Staff interviews as well as documentation indicate facility is currently staffing at the following levels: First shift is two caregivers at 6AM and one at 10AM. Second shift is two caregivers as well as two on the overnight shift. There is a Medication Technician for each shift. Review of facility staffing from September 2020 through January 2021 indicate facility worked with a varied level of caregivers ranging from two to four. Facility did not use a staffing agency to fill holes during Covid surge rather utilized public health guidelines allowing Covid positive asymptomatic staff to work with Covid positive residents. CONTINUED ON LIC 9099C DATED 06/24/2021.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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 2
Control Number 22-AS-20210119165620
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: 06/24/2021
NARRATIVE
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Due to conflicting information, LPA is unable to corroborate allegation. Therefore the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with and a copy of this report was provided to facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2