Flanders Court of Carmel

Type of visit: Case Management - Incident

On 10/5/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a case management inspection. LPA met with administrator Michael Hagerty and announced the purpose of the inspection. This inspection was conducted to follow-up on an incident which was reported to Community Care Licensing Division(CCLD) on 10/3/2023. During the visit, LPA toured the facility, inspected resident bedrooms and bathrooms, and requested records. No deficiencies were cited during the inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 5, 2023

Type of visit: Required - 1 Year

On 3/27/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with Licensee Herman Fickewirth. Administrator certificate was current with expiration date 9/3/2023. There were 2 residents on hospice at the time of the inspection. LPA toured the facility inside and outside. Pathways and doors were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility was clean and odor free. LPA observed sufficient amount of perishable and non-perishable foodstuffs. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. Sharp items were secured in a locked drawer in the garage. A locked cabinet was observed to store resident medications, and medications appeared to be administered properly. The fence had a self-locking latch mechanism, and there was adequate outdoor seating for residents. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed staff and resident files. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan, and a copy of current Administrator’s Certificate to update the facility file. No deficiencies were cited during the inspection, exit interview conducted with Licensee, a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2023

Type of visit: Case Management - Health Checks

On 10/19/22, Licensing Program Analysts (LPAs) M. Medina and S. Hurt conducted a Case Management Health and Safety visit to follow up on based on observations made during an unrelated Complaint Investigation conducted on 8/31/22. LPAs observed facility continues to be over licensed capacity and observed the facility to be storing unused wheel chairs, walkers, chairs, space heaters in the bathrooms showers and areas of the patio outside of exits. LPA Medina received a updated copy of LIC 9020 during visit. Deficiencies cited on the attached 809-D. Exit interview conducted. Appeal rights provided and a copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Oct 19, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Oct 20, 2022

Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. **This was not met as evidenced by LPA observed 8 residents currently in facility of which a2re identified as Independent Living.the state’s words, verbatim · CDSS document, Oct 19, 2022

Plan of correction: Licensee to submit written plan by POC due date to bring facility into compliance. Licensee/Administrator to continue to work with APS to find suitable housing to meet resident needs. Licensee/Administrator to contact Department no later than 11/21/22 with updates and relocation information for residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Nov 4, 2022

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. **This was not met as evidenced observation of facility storing unused wheel chairs, walkers, chairs, space heaters in the bathrooms showers and areas of the patio outside of exits.the state’s words, verbatim · CDSS document, Oct 19, 2022

Plan of correction: Licensee to ensure that all excess unused wheelchairs, walkers, chairs, space heaters be properly stored and not in areas intended for use of residents.

Allegation investigated: Facility is over ratio Resident is locked in room

On 8/31/2022, Licensing Program Analyst (LPA) M. Medina conducted a subsequent complaint visit. LPA introduced self, stated purpose of visit, and allowed entrance into facility. LPA met with Licensee, Herman Fickerwirth and Administrator, Michael Hagerty. LPA Medina toured entire facility with Licensee and Administrator. LPA observed that there are currently 9 residents residing in facility of which 3 are identified as independent living. LPA observed 2 bedrooms (R1 & R2) to have exit doors being blocked. Based on LPA observation and interviews, the preponderance of evidence standard has been met therefore the allegation is found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An immediate civil penalty of $500 is assessed. An exit interview was conducted with Michael Hagerty, Administrator. A copy of this report and appeal rights were discussed and provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 31, 2022 · control 24-AS-20220808120217

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Sep 1, 2022

Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. **This was not met as evidenced by LPA observed 9 residents currently in facility of which 3 are identified as Independent Living.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Licensee to submit written plan by POC due date to bring facility into compliance. Licensee/Administrator to continue to work with APS to find suitable housing to meet resident needs. Licensee/Administrator to contact Department no later than 9/30/22 with updates and relocation information for residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Sep 1, 2022

Personal Rights of Residents in All Facilities a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. **This was not met as evidenced by LPA observed 2 bedrooms (R1 & R2) to have exit doors being blocked.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Licensee to move items blocking doors in R1 & R2 bedrooms and ensure they remain clear

Type of visit: Case Management - Other

On 8/31/2022, Licensing Program Analysts (LPA) M. Medina conducted a Case Management based on observations made during an unrelated Complaint Investigation. Facility toured. During the course of complaint investigation conducted, staff files were reviewed, LPA observed no training documents on file since 2019 or proof of first aid of first aid for S#1. Training records for staff #2 are incomplete. Facility sketch has changed and has not been reported to department. Deficiencies cited on the attached 809-D. Exit interview conducted. A copy of this report was provided for facility records. .the state’s words, verbatim · CDSS document, Aug 31, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Sep 30, 2022

All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 **This was not evidenced by no training documents on file since 2019 or proof of first aid of first aid for S#1. Training records for staff #2 are incomplete.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Licensee to submit proof of training and proof of first aid for S#1 and completed training records for S#2 to Department by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a)(7) · Plan of correction due date: Sep 9, 2022

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:(7) Sketches, showing dimensions. **This was not met as evidenced by facility has added a building in back yard, use of rooms in facility has changed.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Licensee to submit updated floor plan and LIC 9054 to Department by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit April 24, 2022 at 9:00 a.m. for the facility’s annual inspection. LPA met with Administrator Michael Hagerty, Continual Administrator's Certification expires 09/03/2023. There are currently 5 residents who reside at this home and there is 3 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. LPA observed sufficient supply of bedding linens in facility closet. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed resident as needed PRN medications not being logged in Medication Administration Record. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 109 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA observed all staff working is background cleared. LPA reviewed staff files and all have vaccine exemption forms or vaccination records. The following deficiencies were cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Administrator Michael Hagerty and copy of report left at facilitythe state’s words, verbatim · CDSS document, Apr 24, 2022