306005999-10-26-2023-22-AS-AORZ-CX7TJV-20231102144654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005999
Report Date: 10/26/2023
Date Signed: 10/26/2023 11:29:53 AM

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
08/17/2022 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20220817114947

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: 48	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Aurelia Olais		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Facility did not pick resident up from the hospital.
Facility failed to provide supervision resulting in resident falling

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 resident appraisal. Regarding the allegations that facility did not pick resident up from the hospital and facility failed to provide supervision resulting in resident falling, the investigation revealed the following: Resident 1 (R1) was hospitalized on 08/16/2022 after an unwitnessed fall at the facility. Resident was found outside the resident's room around 7:50 PM. Resident diagnosis was abrasion to the scalp and laceration without foreign body of nose. Resident was treated and hospital contacted facility for resident pick up. Facility contacted resident's family for pick up and resident returned to the facility. Facility indicates the first protocol is to contact the family for pick up and if that is not possible they can arrange for an ambulance pick up. Department regulations indicate facility must arrange or assist in arranging transportation for CONTINUED ON LIC 9099C DATED 10/26/2023.

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: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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-20220817114947

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: 10/26/2023

NARRATIVE

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medical services. Four out of four staff indicate resident was always walking and staff would follow the resident as the resident walked. Resident was being observed all the time with frequent checks. The resident was always moving and out of the resident's room and they could not force the resident to stop. The NOC shift was aware of frequent checks on the resident as well. Due to conflicting information, LPA is unable to corroborate the allegations. Based on interviews conducted, 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 Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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