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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005999
Report Date:
01/13/2022
Date Signed:
01/13/2022 11:05:43 AM
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, THE
FACILITY NUMBER:
306005999
ADMINISTRATOR:
HASSAN, DILUVAN
FACILITY TYPE:
740
ADDRESS:
6041 KINGMAN AVENUE
TELEPHONE:
(800) 570-2273
CITY:
BUENA PARK
STATE:
CA
ZIP CODE:
90621
CAPACITY:
55
CENSUS:
DATE:
01/13/2022
TYPE OF VISIT:
Prelicensing
ANNOUNCED
TIME BEGAN:
10:10 AM
MET WITH:
Aurelia Olais and Dillon Hassan
TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to follow up on a pre-licensing inspection conducted on 12/17/2021. LPA identified herself and discussed the purpose of the visit with Administrator Aurelia Olais. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 04/09/2021 for a capacity of fifty five non-ambulatory residents. Administrator Aurelia Olais has an administrator certificate expiring on 11/22/2022. Licensee Dillon Hassan was present as well.
LPA Lyman along with Administrator Olais toured the facility at 10:35 AM and observed the following:
Dresser drawers in rooms 11.16. and 26 have been replaced.
Walkers and wheelchairs have been removed from the outside path.
The discoloration on walls in rooms 7 and 9 have been removed.
Facility has installed handrails in the main hallway.
Cupboards in shower rooms have been replaced.
Facility is ready to be licensed.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME:
Alisa Ortiz
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Kimberly Lyman
TELEPHONE:
(714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE:
01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/13/2022
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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