Residential Care Services - Washington...Residential Care Services Investigation Summary Report Refer to Statement of Deficiency dated 07/05/2016. WAC 388-76-10355(6)(a)(d)- negotiated

Residential Care Services Investigation Summary Report

Provider/Facility: SELVERMOON ADULT FAMILY HOME(688177)

Intake ID(s): 3218727

License/Cert. #: AF750926Investigator: Atanasova, Elena Region/Unit: RCS Region 2/Unit E Investigation

Date(s):07/05/201607/07/2016

through

Complainant Contact Date(s):Allegations:#1. Named Resident has experienced a 30-lb weight loss in the past year. This was intentional initially as worked hard withthe dietician to achieve weight loss. Named Resident was unable to purchase to have snacks to eat due to financialconstraints and feels hungry a lot of the time. does eat meals but would also like to have snacks so has to purchasethem on own.

Investigation Methods:Sample: residents Observations: general care, meal

preparation, emergencyfood supplies,

Interviews: residents, caregivers,person not affiliated withthe home

Record Reviews: residents' record,caregivers' record

Allegation Summary:#1. Observation found four residents residing in the adult family home(AFH).Named Resident(NR) said had enough food witha lots of variety. said gained 6ponds in the last few months. NR said the Provider sometime bought yogurt for the NR'ssnack but most of the time the NR bought snack on her own. In interview, the Provider said she bought yogurt for the NR snackand the NR did not miss yogurt for more than one day. The Provider said NR liked to buy her onw yogurt sometime. Observationfound the AFH had a 5 pack of yogurt in the refrigerator. The Provider said she bought it. There also was a 908 gram jar withyogurt with the NR's name written on the top. The Provider said this belonged to the NR. The AFH did not document on the NR'snegotiated care plan her snacks preferences and how the home accommodate those.

Unalleged Violation(s):One of the resident was placed to sleep on the mattress on the floor in the common room which compromised her privacy anddignity. The AFH allowed a caregiver to work after the 200 days of hired and she was not certified home care aid.

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

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Residential Care Services Investigation Summary Report

Refer to Statement of Deficiency dated 07/05/2016.WAC 388-76-10355(6)(a)(d)- negotiated care plan- snack.WAC 388-76-10575(1)(a), 10620(1),10705(2)(c)-resident rights, common area, quality of lifeWAC 388-112-0106(1)- long term care worker must became certified within 200 days of hire

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