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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005199
Report Date: 02/09/2022
Date Signed: 02/09/2022 11:54:15 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
11/30/2020 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20201130140717
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:0CENSUS: 43DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Aurelia OlaisTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Staff do not report incidences to the responsible party
Staff moved resident without the responsible party's permission.
Staff do not communicate with the responsible party.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kimberly Lyman and Claudia Gutierrez made an unannounced complaint visit to deliver findings on the above allegations. LPAs met with Administrator Aurelia Olais and explained the reason for the visit.
During the course of the investigation, LPA interviewed staff as well as reviewed and obtained pertinent documentation such as physician report and billing records. Regarding the allegations that staff do not report incidences to the responsible party, staff moved resident without the responsible party's permission, and staff do not communicate with the responsible party, the investigation revealed the following: Resident 1 (R1) tested positive for Covid-19 during a covid surge at the facility. OC Public Health came in and set up "Red zones" and moved covid positive residents into the zones. R1 was moved from a private room into the zone. Facility staff indicate communicating the situation to R1's responsible party at the time. Former Administrator indicates staffing issues may have made communication more difficult at times but nurses and med techs were very involved with the families. R1 had a fall on 11/28/2020. Staff 1 (S1) indicates advising responsible party of the fall and sending R1 to the hospital per responsible party's guidance. CONTINUED ON LIC 9099C DATED 02/09/2022
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: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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-20201130140717
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: 02/09/2022
NARRATIVE
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Both S1 and current Administrator indicate advising responsible party of all situations pertaining to R1. Due to conflicting information, LPA is unable to corroborate allegations. Therefore the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations 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: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
11/30/2020 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20201130140717

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:0CENSUS: 43DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Aurelia OlaisTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff charging responsible party for a room no longer inhabited by the resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kimberly Lyman and Claudia Gutierrez made an unannounced complaint visit to deliver findings on the above allegation. LPAs met with Administrator Aurelia Olais and explained the reason for the visit.
During the course of the investigation, LPA interviewed staff and witness as well as reviewed and obtained pertinent documentation such as billing records. Regarding the allegation that staff charging responsible party for a room no longer inhabited by the resident, the investigation revealed the following: Resident 1 (R1) was moved to a shared room due to covid outbreak. R1 was given a $500 credit due to not residing in a private room. The resident received the annual increase of $189 bringing the charge for two months to $3189 instead of $3689. The fee was changed to $3689 once resident moved back into the private room. Therefore the allegation is deemed unfounded meaning the allegation is false, could not have happened and/ or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3