this do cument - washington...incident log / reports facility p & p page 1 of2 this do cument w /...
TRANSCRIPT
-
This document w
as prepared by Residential Care Services for the Locator website.
-
Residential Care Services Investigation Summary Report
Provider/Facility: CHARLTON PLACE (689036) Intake ID(s): 3663000
License/Cert. #: AL2120Investigator: Gijima, Carol Region/Unit: RCS Region 3/Unit A InvestigationDate(s):
08/16/201910/07/2019
through
Complainant Contact Date(s):Allegations:1. Resident had injuries of unknown source.
Investigation Methods:Sample: 2 of 2 residents including
2 discharged residentsObservations: Named resident's room
Residents in their roomsStaff-to-residentinteractions
Interviews: ResidentsResident representativeStaffCollateral contacts
Record Reviews: Resident CharacteristicRosterResident assessmentsand negotiated serviceagreements includingclosed records of thenamed residentIncident log / reportsFacility P & P
Allegation Summary:1. Resident sustained a fall with injury. The Assisted Living Facility (ALF) failed to investigate the cause of resident's multiplefalls. Failed provider practice identified. See citation below
Unalleged Violation(s): Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
WAC 388-78A-2700 (2), c-i-ii Safety measures and disaster preparedness.
Page 1 of 2
This document w
as prepared by Residential Care Services for the Locator website.
-
Residential Care Services Investigation Summary Report
Page 2 of 2
This document w
as prepared by Residential Care Services for the Locator website.
-
Residential Care Services Investigation Summary Report
Provider/Facility: CHARLTON PLACE (689036) Intake ID(s): 3663197
License/Cert. #: AL2120Investigator: Gijima, Carol Region/Unit: RCS Region 3/Unit A InvestigationDate(s):
08/16/201910/07/2019
through
Complainant Contact Date(s):Allegations:1. Resident's representative and hospice were not notified of resident's injuries.2. Resident's room had black mold and windows did not close all the way.3. Resident has had multiple falls.4. Resident probably had wallet stolen.
Investigation Methods:Sample: 2 of 2 residents including
2 discharged residentsObservations: Named resident's room
Residents in their roomsStaff-to-residentinteractions
Interviews: ResidentsNamed resident'srepresentativeStaffCollateral contacts
Record Reviews: Resident CharacteristicRosterResident assessmentsand negotiated serviceagreements includingclosed records of thenamed residentMedication administrationrecords (MAR)Treatment administrationrecords (TAR)Staff progress notesMedical recordsIncident log / reportsFacility P & P
Page 1 of 2
This document w
as prepared by Residential Care Services for the Locator website.
-
Residential Care Services Investigation Summary Report
Allegation Summary:1. Resident sustained a fall. Hospice and representative were notified. No failed facility practice identified.2. Windows in resident's room were not cleaned, and did not have black mold on windowsill. Windows closed all the way withsome effort. No failed facility practice identified.3. Resident had multiple falls. Assisted Living Facility (ALF) failed to investigate the causes of the falls. Failed facility practiceidentified. See citation below.4. There were no reports made to ALF regarding a lost wallet. No failed facility practice identified.
Unalleged Violation(s): Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
WAC 388-78A-2700 (2) c-i-ii Safety measures and disaster preparedness
Page 2 of 2
This document w
as prepared by Residential Care Services for the Locator website.
-
This document w
as prepared by Residential Care Services for the Locator website.
-
This document w
as prepared by Residential Care Services for the Locator website.