Residential Care Services Investigation Summary Report

Provider/Facility: A Home For You LLC (912591) Intake ID(s): 3465167

License/Cert. #: AF752932Investigator: Valentine, Maureen Region/Unit: RCS Region 2/Unit B Investigation

Date(s):12/22/201712/29/2017

through

Complainant Contact Date(s):Allegations:1) A resident fell resulting in a fracture.

Investigation Methods:Sample: 1 current resident, 1

former named residentObservations: Environment

(interior/exterior), staff toresident interactions,resident to residentinteractions

Interviews: 1 resident, 1 familymember, caregiver,provider

Record Reviews: 3 current clinical records,1 closed clinical record ofnamed resident, incidentreport

Allegation Summary:1) The resident had a alarm and was taken to bed per his/her request. The caregiver left the room to assist another residentand the alarm went off. When the caregiver arrived the resident was on the floor. The medics were called and the resident wastaken to the emergency room for further evaluation. All parties were notified. The investigation was thorough and timely.

Unalleged Violation(s):WAC 388-76-10380(2)WAC 388-76-10375(1)

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-76-10380(2)WAC 388-76-10375(1)

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