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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005999
Report Date: 05/30/2024
Date Signed: 05/30/2024 04:16:07 PM


Document Has Been Signed on 05/30/2024 04:16 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 RO, 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:
05/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Aurelia Olais- Administrator
Paula Tangloa- Resident Care Director		TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessica Cho continued an unannounced Case-Management visit after delivering the findings in connection to Complaint Control Number: 22-AS-20240321121345. The purpose of this visit is to issue a deficiency that was discovered during the investigation mentioned above.

LPA explained the reason for the visit to Administrator Aurelia Olais and Resident Care Director Paula Tanglao. During the investigation, it was discovered that Resident #1 (R1) presented an unknown rash that was alleged as scabies which spread throughout R1's body. Although the facility requested a skin test to R1's hospice agency, facility failed to pursue a skin test (or seek medical care) to ensure that the resident's needs are being met. Per record review, R1 was prescribed Ivermectin and Permethrin which is commonly used to treat scabies. The skin rash cleared after the treatments.

Therefore, based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met.

A deficiency is being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. Please see the attached LIC809-D.

An exit interview was conducted with Administrator Aurelia Olais and Resident Care Director Paula Tanglao, and a copy of this report including the LIC809-D were provided at the end of the visit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024
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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Document Has Been Signed on 05/30/2024 04:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: COTTAGES AT ARTESIA, THE
FACILITY NUMBER: 306005999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2024
Section Cited
CCR
87465(a)(1)

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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed...and provide for assistance in obtaining such care...: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
This requirement was not met as evidenced by:
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Adminstrator to develop a plan of care for all skin skin rashes moving forward and to submit an Aknowledgement of Understanding for the said deficiency to LPA via email by POC due date.
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Based on interviews and record review, although R1 was not tested for scabies, the medications prescribed to treat scabies resolved the skin rash which poses a potential risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024
LIC809 (FAS) - (06/04)
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