Residential Care Services Investigation Summary Report

Provider/Facility: Apple Tree Living Facility Inc(750874)

Intake ID(s): 3250247

License/Cert. #: AF752419Investigator: Beckel, Amy Region/Unit: RCS Region 3/Unit E Investigation

Date(s):08/02/201608/08/2016

through

Complainant Contact Date(s): 08/02/2016, 08/08/2016Allegations:Physical Environment:During an onsite visit by department representatives in May 2015, an unidentified adult and young child were heard in anunfinished and potentially unsafe area which had the access stairwell secured by a padlock.

Investigation Methods:Sample: 3 residents Observations: resident environment

including common areas,bathrooms, and residentrooms; access points andstaircases to upstairslevel of home; upstairsrooms and corridors;safety features such asfire extinguishers andsmoke detectors;resident supplies

Interviews: residents; officemanager; caregivers;owner; provider; othersnot associated with thehome

Record Reviews: facility records,department records, staffrecords

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Residential Care Services Investigation Summary Report

Allegation Summary:A tour of the home revealed several staff members living on the second level of the home (an area not licensed for residents).The area was accessible by both interior and exterior staircases secured by locking doors.The living quarters appeared to befinished although common areas and corridors upstairs were more unfinished. The provider said the person identified as theadult upstairs in 2015 was a former caregiver entertaining a visiting family member. The former caregiver was out of state andnot available for interview.Caregivers, staff, the provider, and the owner of the home all denied securing the stairwell with apadlock. Interviews with department staff and review of department records resulted in a lack of conclusive data regarding anyarea being secured with a padlock in a way that could cause danger to a person upstairs. A representative of the local buildingjurisdiction explained the second level had been approved for occupancy by care-providing and other staff of the home.Interviewed residents said they and other residents did not go upstairs and did not have safety concerns.

Unalleged Violation(s):Failed practice related to both alleged and unalleged issues was identified. See Statement of Deficiencies dated 08/08/2016.

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

See Statement of Deficiencies dated 08/08/2016.

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Residential Care Services Investigation Summary Report

Provider/Facility: Apple Tree Living Facility Inc(750874)

Intake ID(s): 3245941

License/Cert. #: AF752419Investigator: Beckel, Amy Region/Unit: RCS Region 3/Unit E Investigation

Date(s):07/18/201607/21/2016

through

Complainant Contact Date(s): 07/13/2016Allegations:Quality of Care and Treatment: home not correctly disposing of unused/expired medications

Investigation Methods:Sample: 4 residents Observations: general environment;

resident appearance anddemeanor; medicationstorage

Interviews: residents; caregiver;office manager; provider;others not associatedwith the home

Record Reviews: resident records, facilitypolicy

Allegation Summary:Medications and medication records on-site were observed and reviewed and found to be current for all sampled residents.Unused and/or expired medications for two sampled residents had not been disposed of and were observed stored in an off-site,empty facility. The provider and office manager said they had not followed their medication disposal policy.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

See Statement of Deficiencies dated 07/21/2016.

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