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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006155
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:19:14 PM


Document Has Been Signed on 04/03/2024 04:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
306006155
ADMINISTRATOR:OLAIS, AURELIAFACILITY TYPE:
740
ADDRESS:8792 CERRITOS AVENUETELEPHONE:
(657) 256-1063
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:38CENSUS: 29DATE:
04/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Aurelia Olais, AdministratorTIME COMPLETED:
04:35 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the plan of corrections for one type B deficiency cited during the investigation of complaint #22-AS-20240213154220.. LPA was greeted and granted entry by facility staff after explaining the reason of the visit. Administrator Aurelia Olais was present and assisted with the visit.

On February 27, 2024, LPA issued a type B citation for failure to meet the requirements of the California Code of Regulations Section CCR 87303(i)(1)(A) regarding Maintenance and Operations on the operation and accessibility of the facility's call system.

During today's visit, LPA verified that the pull cords for the call system were within reach of the residents and that the missing pull cords had been replaced. A proof of an in-service training conducted on February 28, 2024 was provided to LPA by facility administrator via email. During the visit, at least three residents were observed to be provided with an inaccessible pull cord, including one resident for whom the pull cord was positioned at the foot of the bed with no ability to adequately alert facility staff.

As a result, a civil penalty is assessed for failure to correct the earlier violation of the California Code of Regulations for the seven-day period from March 28, 2024 until April 3, 2024.

An exit interview was provided and a copy of this report along with appeal rights and civil penalty assessmenr were provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
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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