Residential Care Services - Washington · 2019-03-08 · Residential Care Services Investigation Summary Report Provider/Facility: Horseshoe Lake Adult Family Home LLC (688426) Intake

Residential Care Services Investigation Summary Report

Provider/Facility: Horseshoe Lake Adult Family HomeLLC (688426)

Intake ID(s): 3551390

License/Cert. #: AF751235Investigator: Goulet, Michael Region/Unit: RCS Region 3/Unit A Investigation

Date(s):08/14/201808/22/2018

through

Complainant Contact Date(s): 08/13/2018, 08/23/2018Allegations:1) Resident placed on public transport by staff and not Access shuttle; resident not able to navigate the community withoutassistance per assessment.

Investigation Methods:Sample: one of one residents,

including named residentObservations: General environment

Residents in their roomsStaff to residentinteractions

Interviews: ResidentsStaffPersons not associatedwith the facility

Record Reviews: Resident AssessmentResident Care Plan

Allegation Summary:1) Per interviews with resident and staff, and per record reviews of the resident's assessment and care plan, it was determinedthat the facility staff failed to ensure that the resident was assisted when out of the facility as evidenced by staff placing theresident on a public bus instead of the Access shuttle as planned. The staff who allowed the resident to get on publictransportation was not aware of the need for the resident to be taken only by Access shuttle, and the facility care plan for theresident was not in accordance with the resident's assessment.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Care and Services 388-76-10400 (4)

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