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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 270708695
Report Date: 12/26/2024
Date Signed: 12/27/2024 08:27:28 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240821091523
FACILITY NAME:AGAPE OF CARMELFACILITY NUMBER:
270708695
ADMINISTRATOR:FICKEWIRTH, MIRIAMFACILITY TYPE:
740
ADDRESS:25527 FLANDERS DRIVETELEPHONE:
(831) 626-1032
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:6CENSUS: 6DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Miriam FickewirthTIME COMPLETED:
02:46 PM
ALLEGATION(S):
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Staff do not assist residents with care needs in a timely manner.
Staff do not ensure facility cleanliness is maintained.
Staff do not ensure the safety of food served to residents.
Licensee does not ensure a safe and healthful environment is provided for residents.
Staff do not seek timely medical attention for residents.
Licensee does not provide residents with adequate food service.
Licensee does not provide planned activities for residents.
Staff did not dispense medication to resident as prescribed.
INVESTIGATION FINDINGS:
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On 12/26/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Miriam Fickewirth and stated the purpose of the visit. During this visit LPA toured the facility inside and out, performing safety checks and observed residents in care.

Allegation: Staff do not assist residents with care needs in a timely manner. During this visit LPA observed facility, interviewed staff, residents, and residents’ responsible parties. Based on statement provided above, no concerns form staff, residents, or resident responsible parties or LPA observation observed or reported. 5 out of 6 residents pleased with facility operations and reported no to concerns. One out of six resident is on hospice and unable to speak, although POA for that resident responded no to concerns.
Allegation: Staff do not ensure facility cleanliness is maintained. Based on facility tour including residents’ rooms, bathrooms, kitchen, common area and outside yard. LPA also interviewed facility staff and residents during which no concerns observed or/and reported during file review. Based on staff interviews the facility cleaned by staff daily.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
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 2
Control Number 24-AS-20240821091523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: AGAPE OF CARMEL
FACILITY NUMBER: 270708695
VISIT DATE: 12/26/2024
NARRATIVE
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Staff do not ensure the safety of food served to residents. Based on kitchen tour, food supply review of perishable and non-perishable food storage no violations observed. During facility visit on 8/22/24, residents and staff interviews no food concerns reported and /or observed. Per interviews that staff does groceries shopping twice a week.

Allegation: Licensee does not ensure a safe and healthful environment is provided for residents. Based on observations during facility visits, residents’ interviews and records review no concerns observed or reported.

Allegation: Staff do not seek timely medical attention for residents. Based on residents and family interviews the facility provide services as expected. Based on staff interviews all staff aware contacts for medical attention when needed. Based on observations, the facility had emergency contact numbers posted.

Allegation: Licensee does not provide residents with adequate food service. Based on residents and family interview no concerns of food served to residents reported and/or provided. Based on records reviews all residents receive meals according to residents' diet records.

Allegation: Licensee does not provide planned activities for residents. Based on observation during facility visit on 08/22/24 residents spent time outdoor touring the property, feeding birds outside by a large bird cage. Based on family interviews residents are taken on outings by family couple times a week.

Allegation: Staff did not dispense medication to resident as prescribed. Based on records review, 6 out of 6 residents medications provided as prescribed.

Although the above allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Exit interview conducted, report signed and copy of this report provided to administrator for facility records.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2