<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005999
Report Date: 02/29/2024
Date Signed: 02/29/2024 03:40:35 PM


Document Has Been Signed on 02/29/2024 03:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:COTTAGES AT ARTESIA, THEFACILITY NUMBER:
306005999
ADMINISTRATOR:OLAIS, AURELIAFACILITY TYPE:
740
ADDRESS:6041 KINGMAN AVENUETELEPHONE:
(800) 570-2273
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:55CENSUS: 49DATE:
02/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Aurelia Olais - AdministratorTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of
conducting a required annual inspection. LPA was greeted and granted entry into facility by Resident Care Coordinator (RCC) Paula Tanglao and brought to the facility's office located in a residence immediately next door to the facility. LPA met with Administrator (AD) Aurelia Olais at the home office next door to the facility.

The facility is a one-story complex with twenty-eight resident apartments. Each apartment has either its own private bathroom or shares a jack-and-jill style bathroom with another apartment. The facility also houses two common bathrooms, three large shower rooms, kitchen, dining room, living room, sunroom, laundry room, activity room and medication room. Facility appears clean, safe and sanitary. All resident apartments had the required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for clients in storage at the home office next door to the facility. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 109 degrees Fahrenheit in the common bathrooms. LPA observed facility has emergency food and water supply stored at the home office next door to the facility. LPA noted Fire Extinguishers were last serviced on 4/18/2023. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets in the kitchen. Knives are locked up separate from toxic chemicals. The facility houses extra hygiene supplies and chemicals at the home office next door to the facility. Medication for each resident is kept locked in the medication room in the facility. LPA reviewed a service report from Regency Fire indicating that the fire alarm/sprinkler system was last serviced on 11/17/2023. LPA reviewed three resident files and four staff files. LPA observed residents watching TV together in a common area. LPA observed another group of residents participating in a group music/film activity during the time of the inspection. The following are all posted and available for review: emergency phone numbers, activity calendar, menu, necessary postings and the PUB475."

No deficiencies were issued based on today's inspection. An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1