306005999-9-14-2023-22-AS-MVAO-CW3QSV-20230927122610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005999
Report Date: 09/14/2023
Date Signed: 09/14/2023 12:13:49 PM

Unsubstantiated

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
08/29/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230829120121

FACILITY NAME:	COTTAGES AT ARTESIA, THE		FACILITY NUMBER:	306005999
ADMINISTRATOR:	OLAIS, AURELIA		FACILITY TYPE:	740
ADDRESS:	6041 KINGMAN AVENUE		TELEPHONE:	(800) 570-2273
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY:	55	CENSUS: 49	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Aurelia Olais		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff did not take resident to the restroom
Staff left resident in soiled diaper for an extended period of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the course of the investigation, LPA toured the facility, interviewed staff and witness as well as reviewed and obtained pertinent documentation such as physician report and facility notes. Regarding the allegations that staff did not take resident to the restroom and staff left resident in soiled diaper for an extended period of time, the investigation revealed the following: Six out of six staff confirm assisting Resident 1 (R1) to the restroom as needed. All six interviewed deny leaving the resident in soiled diapers and state resident prefers and is capable of using the restroom. Staff indicate resident's behavior is to ask repeatedly to use the restroom and staff state assisting resident. All staff indicated that resident is in a wheelchair in the common areas during daytime hours thus being observed and assisted at all times. During the visit, CONTINUED ON LIC 9099C DATED 09/14/2023

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: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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-20230829120121

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, THE	FACILITY NUMBER: 306005999
	VISIT DATE: 09/14/2023

NARRATIVE

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LPA observed residents in the activity room being observed by staff. R1 came to the facility from a skilled nursing facility in need of a wheelchair. Facility provided a wheelchair to resident while waiting for home health to provide a wheelchair. Staff indicate the process usually takes between 1-2 months for the order to be approved and LPA observed the delivered wheelchair during today's visit. LPA observed resident during today's visit in the activity room and unsuccessfully attempted to speak with resident. Per physician report dated 07/12/2023, R1 is diagnosed with Dementia and is able to care for toileting need with minimal assistance. 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 violation occurred. An exit interview was conducted and a copy of this report was provided via email.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

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