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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006155
Report Date: 11/15/2023
Date Signed: 11/15/2023 01:13:00 PM

Document Has Been Signed on 11/15/2023 01:13 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
CCLD Regional Office, 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: 27DATE:
11/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Aurelia Olais, AdministratorTIME COMPLETED:
01:16 PM
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 On today's date, Licensing Program Analyst (LPA)LPA Quiroz conducted a Case Management-Other inspection visit while conducting ten day inspection visit regarding complaint control #22-AS-20231113104340.
LPA Quiroz met with Administrator (AD) Aurelia Olais and Office Manager (OM) Pamela Bracamonte and discussed purpose of today's Case Management-Other visit.
During today’s visit, LPA Quiroz along with (OM) Bracamonte conducted a facility tour inspection of facility premises. On or about 10:47am, while inspecting dining-room area, LPA Quiroz observed Resident 1 (R1) attempting to fill his water bottle from water system placed in dining-room area. LPA Quiroz observed water system to not be functional and operational as evidenced by (R1) not able to fill their water bottle and requesting water from kitchen staff. (OM) Bracamonte indicated "We had to turn it off because it was leaking." (AD) Olais indicated "I didn't know it was leaking but I will order one today."

LPA Quiroz provided consultation on the following California Code of Regulations: Maintenance and Operation: 87303(a)


(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
(AD) Olais provided receipt invoice of water system purchase during today's visit. An Advisory Note Technical Violation (LIC 9102 TV) was conducted during today's visit addressing CCR 87303(a).

An exit interview was conducted with (AD) Aurelia Olais. A copy of this report along with Confidential Names- LIC 811 and LIC 9102 TV were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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