306005199-11-4-2021-22-AS-AORZ-C8TW2M-20211116155432

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005199
Report Date: 11/04/2021
Date Signed: 11/04/2021 02:21:18 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
10/29/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20201029103527

FACILITY NAME:	COTTAGES AT ARTESIA GARDENS, THE		FACILITY NUMBER:	306005199
ADMINISTRATOR:	AURELIA OLAIS		FACILITY TYPE:	740
ADDRESS:	6041 KINGMAN AVE		TELEPHONE:	(714) 670-1111
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY:	55	CENSUS: 37	DATE:	11/04/2021
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Aurelia Olais		TIME COMPLETED:	02:47 PM

ALLEGATION(S):

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Resident was sexually abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit on this day to deliver findings on a complaint investigation. LPA identified herself and discussed the purpose of the visit and elements of allegation with Administrator Aurelia Olais.

During the course of investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report and resident appraisal. Regarding the allegation that a resident was sexually abused while in care, the investigation revealed the following:

On 10/28/2020, Resident 1 (R1) was being showered by Staff 1 (S1). During this time, Staff 2 (S2) overheard R1 shouting. S2 responded and observed R1 hitting and yelling at S1. S2 excused S1. R1 was yelling at S2 and spit in the staff’s face. S2 attempted to calm R1 and asked R1 what had happened. R1 stated that S1 had slapped the resident’s face. S2 reported the incident to the medication technician who asked R1 about the incident. R1 told the medication technician that S1 CONTINUED ON LIC 9099C DATED 11/04/2021

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20201029103527

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: 11/04/2021

NARRATIVE

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that S1 had squeezed the resident’s face, put the staff’s hands all over the resident’s body and showed R1 their genitals. The facility management was notified as well as Buena Park Police. R1 was instantly assessed and no injuries noted. S1 was immediately put on unpaid leave and was subsequently terminated from employment at the facility. Police Detectives and Department Investigators interviewed S1 who denied the allegation and any wrongdoing. When R1 was interviewed, they were unable to corroborate the allegation and denied anything had happened. Buena Park Police Detectives interviewed R1 and R1 is unable to recall incident. Detective were unable to collect any DNA.

On 10/29/2020, a CareMore Nurse Practitioner assessed R1 and found no evidence of visible injuries or physical evidence to support the allegation of physical or sexual abuse. The Nurse Practitioner indicated that misinterpreting other’s actions are part of the disease process for Dementia and believes that is the case in this situation. Staff members who were interviewed state R1 gave conflicting statements to each and subsequently did not remember the incident. R1’s Responsible Party (RP) states R1 is in a childlike state and observes the Dementia is worsening. RP does not believe the incident occurred however, RP previously requested only female caregivers assist R1 for better results.

R1’s Physician Report dated 02/13/2020 indicates R1 is diagnosed with Dementia with behavioral disturbances as well as depression. R1 is prone to aggression, delusion, and exit seeking behaviors. The facility documentation obtained and reviewed dated 11/26/2018 revealed S1 received a verbal and written warning for failure to follow instructions, substandard work performance, and improper and/or unprofessional conduct. S1 indicated their intent at making improvements to their work performance.

There is not enough evidence or corroborating information to support the 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 Administrator and a copy of this report and confidential names list was provided to Administrator.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC9099 (FAS) - (06/04)

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