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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006155
Report Date: 08/26/2024
Date Signed: 08/26/2024 02:45:46 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
11/13/2023 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231113104340
FACILITY NAME:COTTAGES AT ARTESIA ANAHEIM, THEFACILITY NUMBER:
306006155
ADMINISTRATOR:OLAIS, AURELIAFACILITY TYPE:
740
ADDRESS:8792 CERRITOS AVENUETELEPHONE:
(657) 256-1063
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:38CENSUS: 31DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Aurelia OlaisTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff inappropriately touched resident.
Staff threw food at resident.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Administrator (AD) Aurelia Olais and explained the reason for today’s inspection.

The investigation into the allegations that staff inappropriately touched resident and staff threw food at resident revealed the following: During the course of the investigation, Department staff inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, the Facility’s Video Footage regarding Resident #1 (R1), the Facility’s Investigation Summary dated November 8, 2023, the Facility’s Staff Statement dated October 28, 2023, R1’s Physician’s Report dated November 25, 2022, and Staff #1’s (S1) Staff File.

CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20231113104340
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 ANAHEIM, THE
FACILITY NUMBER: 306006155
VISIT DATE: 08/26/2024
NARRATIVE
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Regarding the allegation that staff inappropriately touched resident: it was alleged that on October 27, 2023, R1 was observed crying loudly and reported that S1 inappropriately touched their chest. One staff interviewed stated that on October 27, 2023, R1 told them that the staff who cleans the rooms “grabbed them” but did not provide a name or description of the staff, but the staff also reported that when R1 does not get what they want they engage in behavioral outbursts. Department staff reviewed the Facility’s Video Footage regarding R1 showing the outside of R1’s room, but obtained no information corroborating the allegation. When interviewed, AD stated that they conducted an investigation into the allegation and found no information corroborating that S1 acted inappropriately with residents. Per the Facility’s Investigation Summary dated November 8, 2023, AD interviewed R1, S1, and four other staff and did not obtain information corroborating the allegation. Per the Facility’s Staff Statement dated October 28, 2023, four staff stated that R1 has a history of behavioral outbursts while S1 “is not capable of hitting anyone.” Department staff interviewed R1 who showed some confusion, did not present with any signs of injury or abuse, denied any inappropriate incidents, stated they feel safe living at the facility and have no concerns at the facility, and denied knowing who S1 was. Per R1’s Physician’s Report dated November 25, 2022, R1 has dementia and is noted to have confusion. Per AD, R1 has a history of making false statements and also engages in self-harming behavior and blames the resulting injuries on staff. LPA reviewed the Facility’s Video Footage regarding R1 which shows R1 hitting themselves on the chin with an object and, per AD, R1 accused staff of causing a bruise on their chin after engaging in this behavior. LPA interviewed S1 who denied the allegation. LPA reviewed S1’s Staff File, interviewed five additional residents, and interviewed three additional staff and did not obtain information corroborating the allegation. The information obtained did not corroborate the allegation.

Regarding the allegation that staff threw food at resident: it was alleged that on October 27, 2023, S1 was observed throwing cookies at R1. Department staff reviewed the Facility’s Video Footage regarding R1 showing the outside of R1’s room, but obtained no information corroborating the allegation. When interviewed, AD stated that they conducted an investigation into the allegation and found no information corroborating that S1 acted inappropriately with residents. Per the Facility’s Investigation Summary dated November 8, 2023, AD interviewed R1, S1, and four other staff and did not obtain information corroborating the allegation. Per the Facility’s Staff Statement dated October 28, 2023, four staff stated that R1 has a history of behavioral outbursts while S1 “is not capable of hitting anyone.”
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20231113104340
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 ANAHEIM, THE
FACILITY NUMBER: 306006155
VISIT DATE: 08/26/2024
NARRATIVE
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Department staff interviewed R1 who showed some confusion, did not present with any signs of injury or abuse, denied any inappropriate incidents, stated they feel safe living at the facility and have no concerns at the facility, and denied knowing who S1 was. Per R1’s Physician’s Report dated November 25, 2022, R1 has dementia and is noted to have confusion. LPA interviewed S1 who denied the allegation. LPA reviewed S1’s Staff File, interviewed five additional residents, and interviewed three additional staff and did not obtain information corroborating the allegation. The information obtained did not corroborate the allegation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations that staff inappropriately touched resident and staff threw food at resident occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3