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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006155
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:45:15 PM

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
02/13/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240213154220
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: 33DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Aurelia Olais, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure resident call buttons is accessible to the resident while in bed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 investigation of the allegations listed above and delivering findings to the licensee. LPA was greeted and granted entry by facility staff. Administrator Aurelia Olais arrived later to assist with the visit.

An initial complaint investigation visit tool place on February 22, 2024. LPA requested and obtained the current facility census, facility roster and staff schedule for the months of January and February 2024. Three staff interviews and three resident interviews were conducted. Resident records were requested for three residents, provided and reviewed during the visit. LPA accompanied with administrator toured the physical plant and tested the operation of the call system.
During the present follow-up, LPA accompanied by staff toured the facility and conducted an additional resident interview. The current census was also requested and obtained.
CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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 5
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
02/13/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240213154220

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: 33DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Aurelia Olais, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure facility is adequately staffed to meet residents’ needs.

Staff do not assist resident with transfers in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 investigation of the allegations listed above and delivering findings to the licensee. LPA was greeted and granted entry by facility staff. Administrator Aurelia Olais arrived later to assist with the visit.

An initial complaint investigation visit tool place on February 22, 2024. LPA requested and obtained the current facility census, facility roster and staff schedule for the months of January and February 2024. Three staff interviews and three resident interviews were conducted. Resident records were requested for three residents, provided and reviewed during the visit. LPA accompanied with administrator toured the physical plant and tested the operation of the call system.
During the present follow-up, LPA accompanied by staff toured the facility and conducted an additional resident interview. The current census was also requested and obtained.
CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20240213154220
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: 02/27/2024
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
CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Licensee does not ensure facility is adequately staffed to meet residents’ needs, the following has been concluded: Based on interviews and records reviewed, there is a constant of one med tech and three caregivers present during the AM shift, one med tech and two caregivers during the PM shift and two caregivers during the overnight shift which appears to meet the staffing requirements present in Title 22 of the California Code of Regulations. Interviews with residents were inconclusive as to whether failures to meet the need of care and supervision for individual residents occurred as a result of insufficient staffing.

Regarding the allegation that Staff do not assist resident with transfers in a timely manner, the following has been concluded: Based on records reviewed and interviews conducted, measures such as a task schedule focused on the needs of a specific resident to be transferred in and out of bed were stated to have been implemented during the month of February 2024. Additionally, LPA accompanied by administrator tested the response from staff to an activation of the call system which appeared satisfactory. However, interviews provided accounts of multiple instances during which staff is alleged to have refused to assist or delayed assistance in transferring a resident.

As a result, both allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20240213154220
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: 02/27/2024
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
CONTINUED FROM LIC9099
Regarding the allegation that Staff do not ensure resident call buttons is accessible to the resident while in bed, the following has been concluded: During two separate visits to the facility, LPA observed that pull cords activating the call system to alert staff were missing in at least three distinct units occupied by six residents. In a total of four other units observed, the bedside pull cords were observed to be positioned out of reach from residents, either at the foot of the bed, or behind the bed's head beyond the full rails observed in use as postural support. As a result, the call system is found to be either inaccessible or non-operational for at least 8 of the 33 residents currently admitted.

The allegation is therefore found to be Substantiated, meaning that the preponderance of evidence standard has been met. A corresponding violation is being cited per California Code of Regulations Title 22, Division 6 on the attached form LIC9099-D.

An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20240213154220
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: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2024
Section Cited
CCR
87303(i)(1)(A)
1
2
3
4
5
6
7
Per CCR 87303(i)(1)(A) regarding Maintenance and Operations: "Facilities shall have signal systems which shall meet the following criteria: (A) Operate from each resident's living unit."
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure all pull cords are present and operational. Additionally, an in-service training will be provided to all staff in order to ensure the pull cords are positioned to be accessible to the residents in care.
8
9
10
11
12
13
14
Based on interviews and observation conducted, the signal system was found to be either inaccessible or non-operational due to the absence of a pull cord in multiple units, constituting a potential risk to the health and safety of residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5