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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005199
Report Date: 09/09/2021
Date Signed: 09/09/2021 04:02:33 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:AURELIA OLAISFACILITY TYPE:
740
ADDRESS:6041 KINGMAN AVETELEPHONE:
(800) 570-2273
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:55CENSUS: 34DATE:
09/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Aurelia OlaisTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Business Office Manager Roxanna Sanchez and explained the reason for the visit. Administrator Aurelia Olais was present as well. Administrator Aurelia Olais has an administrator certificate expiring on 11/22/2022. Prospective Licensee Dillon Hassan arrived during the visit.

At 9:30 AM, LPA toured the facility with Administrator Olais. Facility has 34 residents in care during today's visit. LPA observed residents relaxing and participating in activities in the facility. All residents appeared well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the facility. Facility utilizes a visitor sign in sheet. Facility takes resident and staff temperatures daily. Facility has covid precaution postings as well as all required department postings. LPA observed the first aid kit has all required items. Facility mitigation plan has been submitted and is approved. LPA observed an ample supply of emergency food and water. LPA toured the outside grounds and observed multiple shaded outside visitation areas. Exit gates have delayed egress. LPA observed the locked medication room. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed select resident files during the visit and all files are up to date including emergency information.

LPA consulted with Administrator regarding the importance of documenting staff and resident temperatures daily.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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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