This do cument · 2020-01-15 · Residential Care Services Investigation Summary Report...
Transcript of This do cument · 2020-01-15 · Residential Care Services Investigation Summary Report...
This document w
as prepared by Residential Care Services for the Locator website.
Residential Care ServicesInvestigation Summary Report
Provider/Facility: A LITTLE PIECE OF HEAVEN (687104) Intake ID(s): 3671660
License/Cert. #: AF524200Investigator: Singer, Jamie Region/Unit: RCS Region 2/Unit I Investigation
Date(s):10/28/201910/29/2019
through
Complainant Contact Date(s): 10/22/2019, 10/29/2019Allegations:#1. The adult family home (AFH) had not paid the annual licensing fee and was operating the AFH without a valid license.
Investigation Methods:Sample: Resident Observations: Adult Family Home
Environment, ResidentAppearance, Resident toStaff Interaction, Foodand Household Supplies
Interviews: Resident, EntityRepresentative.
Record Reviews: Resident Records, StaffRecords, DepartmentRecords
Allegation Summary:#1. Observation found the AFH provided care and services to five residents. The AFH was operating with all required utilities andsufficient staffing, food and supplies. The AFH failed to pay the annual licensing fee due 08/15/19 and was operating without avalid license.
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 10/29/19.
Page 1 of 1
This document was 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.