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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006155
Report Date: 07/03/2025
Date Signed: 07/03/2025 11:32:51 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
07/11/2024 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240711133659
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: 34DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Rose MartellottiTIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injury while in care
Facility did not seek medical attention in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Hanna Gough arrived at the facility for the purpose of investigating the above mentioned allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Rose Martellotti and discussed the purpose of the visit.

The investigation into the allegations of resident sustained injury while in care and facility did not seek medical attention in a timely manner revealed the following: During the course of the investigation interviews with resident #1 (R1) responsible party revealed that in the morning of July 11, 2024, they notified staff that R1 had an injury and questioned staff of its origins. Staff informed responsible party that R1 did not have injuries the night before and that they will have someone come and look at R1’s reported injuries. It was revealed that 2 of 4 staff observed an injury on R1s arm. On the same day, the person responsible arrived at the facility on or about 3:30pm and observed that R1 had not been addressed and decided to take R1 to the hospital for evaluation. The interview with the previous facility Administrator stated that R1 was sent out to the hospital, but they did not have any injuries. Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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-20240711133659
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: 07/03/2025
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
26
27
28
29
30
31
32
During file review an incident report submitted to the Department stated that on July 11, 2025, staff noticed R1 had redness on their left arm around 8:00am. Medical records from the VA hospital with an admission date of July 11, 2024 revealed that R1 was admitted at 3:41pm due to left arm weakness, pain and left hand swelling. The medical records also stated that R1 had a rash to their inner arm and a possible fall.

Based on observation, interviews, record review and information gathered during the investigation, 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 AD Rose Martellotti and a copy of this report, LIC9099-D and appeal rights were left at the facility.

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

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240711133659
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: 07/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2025
Section Cited
CCR
87464(f)(1)
1
2
3
4
5
6
7
Basic Services 87464(f)(1)
Care and supervision

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Administrator stated they will do an in-service training with staff about providing care and supervision and reporting when residents are denying care or being combative to staff. Administrator will send proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and record review the licensee did not ensure R1 had care and supervision resulting in a hospital visit due to pain, weakness and redness on their arm even though 2 of 4 staff stated they observed the injured arm.
8
9
10
11
12
13
14
Type B
07/24/2025
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
Incidental medical and dental care 87465(a)(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 evidence by:
1
2
3
4
5
6
7
Administrator stated they will do an in-service with staff on arranging and assisting procedures for residents and send proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and record review the licensee did not assist in appropriate medical arrangements for R1 even though staff observed the injured arm at 8:00am resulting in R1 being taken to the hospital by their responsible party with an admission time of 3:41pm.
8
9
10
11
12
13
14
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: 07/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3