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Residential Care Services Investigation Summary Report
Provider/Facility: Cornerstone Care Services Inc(902533)
Intake ID(s): 3291760
License/Cert. #: AF752890Investigator: Shauvin, Sylvia Region/Unit: RCS Region 1/Unit B Investigation
Date(s):01/23/201701/23/2017
through
Complainant Contact Date(s): 01/24/2017, 11/23/2016Allegations:1. Suspected fatal injury from a fall.
Investigation Methods:Sample: 3 current residents
1 former residentObservations: Residents in living
environmentFacility physical plantStaff to resident care andinteractionsfacility's interventions topromote safety
Interviews: 3 residentscaregiver/residentmanagerrelief caregiveradministrator
Record Reviews: Residents' assessmentsand care plansincident log
Allegation Summary:Interviewed residents had no complaints about care and assistance. Safety interventions were in place to promote residentsafety. The facility addressed progressive safety interventions prior to named resident's death. No failed facility practice relatedto said allegation.
Unalleged Violation(s):During this investigation a violation was found related to environmental hazard i.e. elevated crease in the carpet.
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
Violation was documented in the 1/23/17 Statement Of Deficiencies under;Washington Administrative Code 388-76-10750 (1) Safety and maintenance
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