306005999-5-30-2024-22-AS-LMOA-D5T69K-20240531203651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005999
Report Date: 05/30/2024
Date Signed: 05/30/2024 03:25:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
03/21/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240321121345

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:	05/30/2024
		UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Aurelia Olais- Administrator Paula Tangloa- Resident Care Director		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Facility did not implement precautions for scabies outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced subsequent visit for the purpose of continuing the investigation and delivering the findings into the above allegation. LPA explained the reason for the visit and reviewed the allegation with Administrator Aurelia Olais and Resident Care Director Paula Tanglao. During the initial visit on March 26, 2024, LPA interviewed two residents and five staff. Attempts were made to interview three additional residents, however interviews could not be completed at the time. LPA obtained pertinent documentation which includes: Resident Roster, Hopsice Resident Roster, Face Sheets, Phyisician's Reports, Special Incident Report, Care Notes for Resident #1 (R1), and the Infection Control Procedures. On today's date, LPA toured the showers. LPA observed three showers with two shower chairs. One additional interview was conducted today with a resident and records were also obtained. The investigation revealed the following:

Regarding the allegation, Facility did not implement precautions for scabies outbreak, it was alleged R1 having scabies. Five out of the five staff interviewed denied residents and staff having scabies.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 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.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240321121345

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 05/30/2024

NARRATIVE

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The five staff were also able to explain the infection control procedures. A facility staff also indicated that a skin test was requested to R1's hospice agency due to R1 being under their care and R1 presenting an unknown rash. One facility staff and witness interview stated that hospice offers palliative care that is solely symptom focused. Per the hospice charting, R1 was prescribed Ivermectin and Permethrin, to treat the scabies which improved the symptoms and cleared the rash. As of today's date, the diagnosis for the rash is unknown and facility did not pursue a test for R1. One out of the three residents interviewed confirmed having a rash while the remaining residents denied having or witnessing rash on other residents or staff. Three out of the three residents confirmed that the facility cleans and offers laundry services daily.

Therefore, due to conflicting information, LPA is unable to corroborate the allegation. Based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegation: Facility did not implement precautions for scabies outbreak is deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Aurelia Olais and Resident Care Director Paula Tangloa, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

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