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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3659370

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):07/18/201908/28/2019

through

Complainant Contact Date(s): 07/11/2019, 07/25/2019, 08/28/2019Allegations:1. Named Resident was sitting in their wheelchair in the driveway at the bottom of the hill and was requesting assistance toreturn to the AFH. Named Staff was reluctant to assist the resident back to the home.2. Named Resident did not have a signed care plan and has been at the facility for more than a month.3. Named Resident is to have community integration included in their care plan and they do not have information to provide onwhat they are doing to include about plans for community activities.

Investigation Methods:Sample: Two Named Residents

and one dischargedresident

Observations: Environment, drivewayand resident condition

Interviews: Residents, staff andcollateral contacts.

Record Reviews: Resident recordsincluding careplans,assessments, behaviorplans, disclosure ofservices.

Allegation Summary:1. Named Resident said that not all staff were helpful in returning to the AFH. Facility staff said that they are responsible forhelping the resident return to the AFH and do provide assistance.2. Care plan for the Named Resident did not have any signatures. Deficient practice identified.3. Named Resident had been on outings in the community identified by the provider. The case manager and the provider areworking to define activity plans.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Page 1 of 2This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Please see the statement of deficiency dated 08/28/2019. Deficiency identified for failure to have the care plan signed, WAC388-76-10375.

Page 2 of 2This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3661421

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):07/18/201908/28/2019

through

Complainant Contact Date(s): 07/23/2019, 08/27/2019Allegations:1. Named Resident was given an immediate notice to discharge from the facility and not a thirty day notice. There was nolocation to transfer care to listed on the notice but said the case manager would assist with finding a location.

Investigation Methods:Sample: Named Resident's closed

record and two currentresidents

Observations: General environment andgeneral residentcondition

Interviews: Residents, staff andcollateral contacts.

Record Reviews: Resident recordsincluding careplans,assessments andtransfer/discharge notice.

Allegation Summary:1. The Named Resident received a written notice dated 07/03/2019 for discharge /2019 and no location was provided.Deficient practice identified.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Please refer to the statement of deficiency dated 08/28/2019. Failure to plan for a safe and timely discharge to another locationfor care. WAC 388-76-10615.

Page 1 of 1This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3661464

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):07/18/201908/28/2019

through

Complainant Contact Date(s): 07/23/2019, 08/27/2019Allegations:1.Named Resident was given a notice to discharge from the facility. There was no location to transfer care to listed on thenotice.

Investigation Methods:Sample: Named Resident's closed

record and two currentresidents

Observations: Resident recordsincluding care plans,assessments andtransfer/discharge notice.

Interviews: Residents, staff andcollateral contacts.

Record Reviews: Resident recordsincluding care plans,assessments andtransfer/dischargenotices.

Allegation Summary:1. Named Resident received written notice dated 07/03/2019 for discharge /2019 and no location was provided. Deficientpractice identified.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Please refer to the statement of deficiency dated 08/28/2019. Failure to plan for a safe and timely discharge to another locationfor care. WAC 388-76-10615

Page 1 of 1This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3553496

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):09/12/201804/25/2019

through

Complainant Contact Date(s): 09/11/2018, 12/07/2018Allegations:1. Provider made themselves payee despite the resident having a POA and deposited the resident's social security funds intotheir deceased uncle's account.

Investigation Methods:Sample: Named discharged

Resident and one othernow discharged resident.

Observations: General environment,resident room, residentcondition.

Interviews: Residents, staff and othercollateral contacts.

Record Reviews: Resident recordsincluding care plans,assessments, financialdocuments, bank recordsreceipts.

Allegation Summary:1. Named Resident said their money was handled by the provider, they were unsure how to feel about it but they needed ahaircut and that was a way to make it happen. The resident representative said that they were unaware their power of attorneywas revoked until they arrived at the home to assist the resident to move to a new facility. They said that they were notinformed where the bank account was. The provider said that they took the resident to social security and the bank to set up anew payee and establish two new bank accounts.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Deficient practice identified, please see the Statement of Deficiency dated 04/25/2019 with citations for WAC 388-76-10560 andWAC 388-76-10670.

Page 1 of 1This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3603334

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):09/12/201804/25/2019

through

Complainant Contact Date(s): 01/10/2019, 01/14/2019, 05/08/2019, 05/09/2019Allegations:1. Legal Payee is not paying the Named Resident's current facility copay because the resident owes the previous facility money.2. The payee stated intent to keep $50 per month for a year until the debt is gone.3. Named Resident is upset over the money allegations and says they do not know where their money went for 2017.4. The resident is missing clothing.

Investigation Methods:Sample: Named discharged

Resident and one othernow discharged resident.

Observations: General environment,resident room, residentcondition

Interviews: Residents, staff and othercollateral contacts

Record Reviews: Resident recordsincluding care plans,assessments, financialdocuments, bank recordsreceipts.

Allegation Summary:1. The new facility said the resident's bill pay was paid but was late.2. The resident said they received most of their money allotment for the month from the payee after multiple requests after theymoved to a new facility. The facility system for keeping track of the money was not a complete or accurate for the time at theprevious facility.3. The resident said they did not have access to their money or know where their money was kept during the time they lived atthe facility. They were not aware of where or how the money was spent.4. The resident said they had some of their pants thrown away because they were soiled but they did have a couple replaced bystaff. The facility did not have a system for tracking the resident's belongings.

Unalleged Violation(s): Yes No

Page 1 of 2This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Deficient practice identified, please see the Statement of Deficiency dated 04/25/2019 with citation of WAC 388-76-10560.

Page 2 of 2This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3618580

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):03/07/201903/08/2019

through

Complainant Contact Date(s): 03/06/2019, 03/14/2019Allegations:1. A previous investigation determined the owners dog needed to be away from clients. Named Resident reported the ownerplaced the dog in his/her lap trying to get him/her used to the dog and he/she did not like or want that.

Investigation Methods:Sample: Named Resident and two

other current residents.Observations: General environment,

resident rooms, locationof conditions posted,resident condition

Interviews: Residents, staff andcollateral contacts.

Record Reviews: Resident recordsincluding careplans,assessments, notes

Allegation Summary:1. The Named Resident reported the dog was placed on their lap and the lap of their room mate on the same evening. Theowner stated stated they placed the dog on the resident's lap to get acquainted despite the safety plan in place to keep the dogfrom being in contact with residents.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-76-10015-3 was cited for failing to ensure the residents were kept safe.

Page 1 of 1This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Provider/Facility: PIONEER HOME (688952) Intake ID(s): 3606379

License/Cert. #: AF751825Investigator: Knight, Laurel Region/Unit: RCS Region 1/Unit C Investigation

Date(s):01/17/201901/29/2019

through

Complainant Contact Date(s): 01/17/2019, 01/31/2019Allegations:1. Named Resident and an outside service provider were bitten by the facility owner's dog on 01/15/2019. The Residents do notfeel safe.

Investigation Methods:Sample: Named Resident and two

other current residents.Observations: General environment,

common areas, residentcondition, resident injury,resident rooms, locationof petsupplies/bed/feedingbowl.

Interviews: Residents, staff andothers not associatedwith the facility

Record Reviews: Resident recordsincluding careplans,assessments, notes,incident log, pet records

Allegation Summary:1. The Named Resident reported they were scared they were going to be bitten again. The Named Resident was able to showtheir ankle with bruised areas on one side and broken skin with bruised area on the other ankle. Other residents residing in thehome observed the dog biting the bus driver and intervened to prevent injury. Other agency workers that visited the home saidthe dog was often in the common areas and they had to wear boots to prevent a dog bite while visiting.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Page 1 of 2This document was prepared by Residential Care Services for the Locator website.

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Residential Care Services Investigation Summary Report

Statement of Deficiency dated 01/29/2019 included citations for WAC 388-76-10230-1 and 388-76-10230-2. Conditions were putin place.

Page 2 of 2This document was prepared by Residential Care Services for the Locator website.

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This document was prepared by Residential Care Services for the Locator website.


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