REDMOND SENIOR CARE AFH 5039 158TH AVE NE...RALUCA DONDOS REDMOND SENIOR CARE AFH 5039 158TH AVE NE...
Transcript of REDMOND SENIOR CARE AFH 5039 158TH AVE NE...RALUCA DONDOS REDMOND SENIOR CARE AFH 5039 158TH AVE NE...
STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICES
AGING AND LONG-TERM SUPPORT ADMINISTRATION20425 72nd Avenue S, Suite 400, Kent, WA 98032-2388
October 4, 2016
RE: REDMOND SENIOR CARE AFH License #752655
Dear Provider:
The Department completed a follow-up inspection of your Adult Family Home onOctober 3, 2016 for the deficiency or deficiencies cited in the report/s dated July 29,2016 and found no deficiencies.
The Department staff who did the inspection:
RALUCA DONDOSREDMOND SENIOR CARE AFH5039 158TH AVE NEREDMOND, WA 98052
Jamie Singer, Community Complaint Investigator
Sincerely,
Bennetta Shoop, Field ManagerRegion 2, Unit EResidential Care Services
If you have any questions please, contact me at (253) 234-6033.
Completion DateLicense #: 752655
July 29, 2016
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REDMOND SENIOR CARE AFHPlan of Correction
STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICES
AGING AND LONG-TERM SUPPORT ADMINISTRATION20425 72nd Avenue S, Suite 400, Kent, WA 98032-2388
Statement of Deficiencies
Licensee: RALUCA DONDOS
Jamie Singer, RN, Community Complaint Investigator
From:
DSHS, Aging and Long-Term Support Administration
Residential Care Services, Region 2, Unit E
20425 72nd Avenue S, Suite 400
Kent, WA 98032-2388
(253)234-6033
You are required to be in compliance with all of the licensing laws and regulations at all times to
maintain your adult family home license.
The department has completed data collection for the unannounced on-site full inspection of:
7/19/2016
REDMOND SENIOR CARE AFH
5039 158TH AVE NE
REDMOND, WA 98052
As a result of the on-site full inspection the department found that you are not in compliance with
the licensing laws and regulations as stated in the cited deficiencies in the enclosed report.
I understand that to maintain an adult family home license I must be in compliance with all the
licensing laws and regulations at all times.
The department staff that inspected the adult family home:
DateResidential Care Services
DateProvider (or Representative)
Completion DateLicense #: 752655
July 29, 2016
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REDMOND SENIOR CARE AFHPlan of Correction
Statement of Deficiencies
Licensee: RALUCA DONDOS
WAC 388-76-10181 Background checks Employment Nondisqualifying information.
(1) If any background check results show that an employee or prospective employee has a
criminal conviction or pending charge for a crime that is not disqualifying under chapter 388-
113 WAC, then the adult family home must:(a) Determine whether the person has the character, competence and suitability to work with
vulnerable adults in long-term care; and(b) Document in writing the basis for making the decision, and make it available to the
department upon request.
Based on observation, interviews and record review, the adult family home (AFH) through its
Entity Representative (ER) failed to have written documentation of how the home determined 1
of 5 sampled staff (Staff C) who had non-disqualifying convictions or pending charges had the
character, suitability and competence to provide care to vulnerable adults. This placed the
home's residents (Residents #1-#5) at risk of harm from exposure and care from unsuitable staff.
Findings include:
Observations, interviews and record review took place 7/19/2016 unless otherwise noted.
During record review of staff files, Staff C had a Washington State name and date of birth
background inquiry (BGI) completed on 3/3/2016. The BGI indicated a negative action from
1994, " ". This is not a disqualifying crime under chapter 388-113
WAC.
The staff record had no documentation in writing to determine whether Staff C had the
character, competence and suitability to work with vulnerable adults.
In interview the ER stated that there was no character, competence and suitability documentation
for Staff C.
Observation found Staff C, with Residents #1-#5, providing unsupervised care in the home
throughout the day.
Attestation Statement
I hereby certify that I have reviewed this report and have taken or will take active measures
to correct this deficiency. By taking this action, REDMOND SENIOR CARE AFH is or
will be in compliance with this law and / or regulation on (Date)________________ . In
addition, I will implement a system to monitor and ensure continued compliance with this
cited deficiency.
Provider (or Representative) Date
This requirement was not met as evidenced by:
Completion DateLicense #: 752655
July 29, 2016
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REDMOND SENIOR CARE AFHPlan of Correction
Statement of Deficiencies
Licensee: RALUCA DONDOS
This is a repeat or uncorrected deficiency previously cited on 3/9/2015
Attestation Statement
I hereby certify that I have reviewed this report and have taken or will take active measures
to correct this deficiency. By taking this action, REDMOND SENIOR CARE AFH is or
will be in compliance with this law and / or regulation on (Date)________________ . In
addition, I will implement a system to monitor and ensure continued compliance with this
cited deficiency.
Provider (or Representative) Date
WAC 388-76-10485 Medication storage. The adult family home must ensure all prescribed
and over-the-counter medications are stored:(1) In locked storage;
Based on interview and observation, the adult family home (AFH) through its Entity
Representative (ER) failed to ensure prescribed medication was kept in locked storage. This
placed the home's ambulatory resident (Resident #4) at risk of misuse of medication and harm.
Findings include:
Observations, interviews and record review took place 7/19/2016 unless otherwise noted.
During the environmental tour, a bottle of prescription 12% (a prescription
lotion) prescribed to Resident #2, was found in the main bathroom's medicine cabinet. The
bathroom is accessible to all residents.
In interview, Staff A was unaware the medication was in the bathroom. Staff A removed the
bottle of 12% and locked it with the home's other medications. Staff A stated
that Resident #4 was cognitively impaired.
Resident #4 was observed ambulating in the home without direct supervision.
This requirement was not met as evidenced by: