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Page 1: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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

Page 2: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care ServicesInvestigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3583624

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1) the named resident in the assisted living facility (ALF)was found on the floor in his apartment.

Investigation Methods:Sample: named resident

7 residentsObservations: 3 residents

general population of theALF

Interviews: 3 residents4 caregiversResident CareCoordinatorMemory Care ProgramCoordinatorHealth & WellnessDirectorExecutive Director

Record Reviews: named resident7 residentsALF's incident andinvestigation reports

Allegation Summary:1) The ALF acted immediately upon discovering the resident on the floor, called 911 for further medical treatment. Aninvestigation was started to determine the circumstances surrounding the incident, and notified all appropriate parties (family,physician and state hotline).

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2470(1) Background check disqualifying negative actions

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

Page 3: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

WAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 4: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3582666

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1) a staff member of the assisted living facility (ALF) stole the named residents narcotics in 2017

Investigation Methods:Sample: named resident

7 residentsObservations: named resident

3 residentsgeneral population of theALF

Interviews: 3 residents4 caregiversResident CareCoordinatorHealth & WellnessDirectorExecutive Director

Record Reviews: named residentnamed staff record7 residentsALF's incident report andinvestigation reportsALF's policy andprocedures

Allegation Summary:1) The ALF acted immediately upon receiving report to initiate a investigation to determine the circumstances surrounding theincident and notified the police and state hotline of the allegation.

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2470(1) Background check disqualifying negative actionsWAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 5: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

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

Page 6: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3581732

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1) The assisted living facility (ALF) did not have hot water in resident rooms in the west hallway of the building

Investigation Methods:Sample: 4 residents Observations: 4 residents

general population of theALFhot water temperature inresident rooms

Interviews: 4 residents1 server2 caregivers2 Licensed NursesMaintenance SupervisorExecutive Director

Record Reviews: ALF's incident reportWater temp logsALF's policy andproceduresRepair invoices

Allegation Summary:1)The ALF acted immediately to call for plumbing repair, provided affected residents with an alternative room supplied with hotwater for bathing, notified all residents of the hot water not working, distributed hand sanitizer and wet wipes to all residents

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2470(1) Background check disqualifying negative actionsWAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 7: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

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

Page 8: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3581048

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1) the named resident in the assisted living facility (ALF) required a higher level of care and had several falls which resulted in asubdural hematoma

Investigation Methods:Sample: named resident

7 residentsObservations: 3 residents

general population of theALF

Interviews: 3 residents4 caregiversMemory Care ProgramCoordinatorHealth & WellnessDirectorExecutive Director

Record Reviews: named resident7 sampled residentsALF's incident andinvestigation reports

Allegation Summary:1) the ALF identified a change in the residents level of care and coordinated with family a move to the ALF's SMCU to bettermeet the residents needs.

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2470(1) Background check disqualifying negative actionsWAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 9: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3580014

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1) the named resident in the secured memory care unit (SMCU) of the assisted living facility (ALF) had a fall and sustained aclosed head injury and fractured nose

Investigation Methods:Sample: named resident

7 residentsObservations: named resident

2 residentsgeneral population of theSMCU and ALF

Interviews: named resident2 residents4 caregiversMemory Care ProgramCoordinatorHealth & WellnessDirectorExecutive Director

Record Reviews: named resident7 residentsALF's incident andinvestigation reports

Allegation Summary:1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation to theER. An investigation was started to determine the circumstances surrounding the fall, notified all appropriate parties (family,physician, community nurse, and state hotline) and interventions were put in place to prevent recurrence.

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

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.

Page 10: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

WAC 388-78A-2470(1) Background check disqualifying negative actionsWAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 11: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3579393

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1)the named resident in the assisted living facility's (ALF) secured memory care unit (SMCU) was found on the floor of theirbedroom with substantial injuries to their skull, back and shoulder.

Investigation Methods:Sample: named resident

7 residentsObservations: named residents room

3 residentsgeneral population of theALF and SMCU

Interviews: 3 residents4 caregiversMemory Care ProgramCoordinatorRegistered NurseExecutive Director

Record Reviews: named resident7 residentsALF's incident andinvestigation reports

Allegation Summary:1) the ALF acted immediately to provide medical care, called 911 for further evaluation and transportation to the hospital,notified all appropriate parties (family/representative, physician, and state hotline), initiated an investigation to determine thecircumstances of the incident and put in place measures to prevent recurrence.

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2470(1) Background check disqualifying negative actionsWAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 12: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

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

Page 13: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

Provider/Facility: Brookdale Monroe (856240) Intake ID(s): 3577797

License/Cert. #: AL2284Investigator: Kaupp, Debbie Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/26/201812/12/2018

through

Complainant Contact Date(s):Allegations:1) the named resident in the assisted living facility (ALF) was found on the floor unresponsive in the bathroom and passed awaylater that day in the hospital.

Investigation Methods:Sample: named resident

7 residentsObservations: 3 residents

general population of theALF

Interviews: 3 residents4 caregiversMemory Care ProgramCoordinatorHealth & WellnessDirectorExecutive Director

Record Reviews: named resident7 residentsALF's incident andinvestigation reports

Allegation Summary:1) the ALF acted immediately upon discovering the resident on the floor to call 911 for further evaluation and medical treatment,initiated an investigation to determine the circumstances surrounding the incident, notified family, community nurse and statehotline.

Unalleged Violation(s):additional deficiencies not related to the original complaint were identified. see statement of deficiencies dated 12/12/18

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2470(1) Background check disqualifying negative actionsWAC 388-78A-2474(4) Training and home care aide certification requirementsWAC 388-78A-2100(2)(b) On-going assessments

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

Page 14: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

Residential Care Services Investigation Summary Report

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

Page 15: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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

Page 16: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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

Page 17: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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

Page 18: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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

Page 19: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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


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