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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006155
Report Date: 06/03/2025
Date Signed: 06/03/2025 11:48:20 AM

Substantiated


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
04/26/2024 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20240426093629
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: 30DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Rose MartellottiTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff neglect led to resident sustaining pressure injury
Staff did not meet resident's medical needs
Reporting Requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough and Licensing Program Manager (LPM) Alisa Ortiz made an unannounced inspection for the purpose of investigating the above mention complaint allegations. LPA and LPM met with Administrator (AD) Rose Martellotti and discussed the purpose of the inspection.

The investigation into the allegations staff neglect led to resident sustaining pressure injury, staff did not meet resident's medical needs and reporting requirements revealed the following: During the course of the inspection the Department interviewed AD Olais at the facility, Four staff members, and the responsible party (RP) of Resident 1(R1). During interviews it was revealed that AD Olais was aware of a blister on R1's foot and that an unknown caregiver had put a patch on it. LPA interviewed four staff members. Of the staff members interviewed two of four staff reported having knowledge of R1's wound but assumed someone else was managing it. The remaining two staff members denied having knoweldge of R1's wound with one of those staff members reporting they did not notice the wound due to R1 not taking their socks off.
Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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-20240426093629
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 ANAHEIM, THE
FACILITY NUMBER: 306006155
VISIT DATE: 06/03/2025
NARRATIVE
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R1's Responsible Party informed the department that they did not know of the wound until it was discovered by R1's doctor during a visit on April 23, 2024. R1's responsible party was not informed by the facility of R1's wound prior, despite two of four staff members being aware of the wound.

During file review it was revealed that the resident’s physician report dated August 17, 2023 stated that the resident does not have the capacity to bathe, dress or groom themselves and is bedridden. The LIC 603A Appraisal dated August 04, 2020 completed by facility staff documents that R1 requires assistance with dressing. An after visit medical summary dated April 23, 2024, was reviewed that stated the resident had a stage 2 pressure ulcer of the right foot. Following the doctor’s visit a home health agency came to the facility to provide wound care to the resident.

Based on observation, interviews, and information gathered during the investigation and review of all documents obtained. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 are being cited on the attached LIC 9099D.

An exit interview was conducted with Administrator Rose Martellotti and a copy of this report, LIC 9099-D, LIC811 and appeal rights were left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240426093629
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 ANAHEIM, THE
FACILITY NUMBER: 306006155
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2025
Section Cited
CCR
87464(f)(1)
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Basic Services 87464(f)(1) Basic services shall at a minimum include: Care and supervision This requirement is not met as evidence by: The licensee did not ensure staff were changing R1's socks resulting in R1 developing a stage 2 ulcer that was not observed or treated timely. Based on
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Licensee stated they will do daily skin integrity checks on all residents and document it and send proof of documentation for two weeks to LPA by POC due date.
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interview and R1 physicians report, R1 required assistance with dressing. This poses a potential risk to resident's health and safety in care.
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Type B
06/24/2025
Section Cited
CCR
87468.1(a)(8)
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Personal Rights of Residents in All Facilities 87468.1(a)(8)
To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs.
The requirement is not met as evidence by:
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Upon record review the licensee conducted an in service training on May 2, 2024 covering reporting with facility staff.
Corrected during time of visit.
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Based on interview and record review the licensee did not comply with the section cited above due to the responsible party not being informed of the resident's medical needs. This poses a potential risk to resident's health and safety 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.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3