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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275294324
Report Date: 10/19/2022
Date Signed: 10/19/2022 02:57:26 PM

Document Has Been Signed on 10/19/2022 02:57 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:FLANDERS COURT OF CARMEL, LLCFACILITY NUMBER:
275294324
ADMINISTRATOR:HAGERTY, MICHAELFACILITY TYPE:
740
ADDRESS:25661 MORSE DRIVETELEPHONE:
(831) 626-0824
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
10/19/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Michael HagertyTIME COMPLETED:
03:30 PM
NARRATIVE
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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.
Melinda HoffmannTELEPHONE: (559) 341-3247
Melinda MedinaTELEPHONE: (559) 410-5914
DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/19/2022 02:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: FLANDERS COURT OF CARMEL, LLC
FACILITY NUMBER: 275294324

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Section Cited
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
Deficient Practice Statement
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POC Due Date: 10/20/2022
Plan of Correction
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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
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melinda HoffmannTELEPHONE: (559) 341-3247
Melinda MedinaTELEPHONE: (559) 410-5914

DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022

LIC809 (FAS) - (06/04)
Page: 2 of 2