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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006155
Report Date:
06/14/2022
Date Signed:
06/14/2022 09:32:05 AM
Document Has Been Signed on
06/14/2022 09:32 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
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
ADMINISTRATOR:
OLAIS, AURELIA
FACILITY TYPE:
740
ADDRESS:
8792 CERRITOS AVENUE
TELEPHONE:
(657) 256-1063
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92804
CAPACITY:
38
CENSUS:
16
DATE:
06/14/2022
TYPE OF VISIT:
Prelicensing
ANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Aurelia Olais - Administrator
TIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an announced visit to The Cottages at Artesia Anaheim. LPA Velazquez was allowed entry into the facility and met with Administrator Aurelia Olais. The purpose of today's subsequent Pre-Licensing visit was to follow-up on the issues that were present during the initial Pre-Licensing visit dated 06/13/2022. The following issues were observed and required correction:
Obtain chairs for the resident rooms
Obtain a First Aid manual
Obtain lamps for the resident rooms
On today's visit the aforementioned items have been addressed and corrected. The items reviewed during this visit are in compliance. The Pre-Licensing is now complete. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. LPA Velazquez reviewed Title 22 Section 87608 Postural Supports and provided a copy of said regulation. Administrator Aurelia Olais acknowledged receiving a copy of this regulation. An exit interview was conducted with Administrator Aurelia Olais and a copy of this report was provided at the time of this visit.
SUPERVISORS NAME
:
Sheila Santos
LICENSING EVALUATOR NAME
:
Patricia Velazquez
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/14/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/14/2022
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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