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Page 1: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

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as prepared by Residential Care Services for the Locator website.

Page 2: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

This document w

as prepared by Residential Care Services for the Locator website.

Page 3: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

This document w

as prepared by Residential Care Services for the Locator website.

Page 4: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

This document w

as prepared by Residential Care Services for the Locator website.

Page 5: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

Page 6: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

This document w

as prepared by Residential Care Services for the Locator website.

Page 7: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

This document w

as prepared by Residential Care Services for the Locator website.

Page 8: This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X

This document w

as prepared by Residential Care Services for the Locator website.

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Plan of Correction Page 9 of 10 License #: 2229 CHATEAU PACIFIC RETIREMENT COMMUNITY Licensee: CP RETIREMENT LLC Completion Date

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X...Page 2 of 4 License #: 630300 COLE ADULT FAMILY HOME Licensee: ELSIE COLE Completion Date August 19, 2019 WAC 388-76-10355 Negotiated

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services, Region 2, Unit E 20425 72nd Avenue S, Suite 400 Kent, WA 98032-2388 (253)234-6033 As a result of the

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019-10-15 · DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, suite 400,

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019. 10. 29. · 1) the ALF acted immediately to evaluate the resident after the fall, call ed911 for further evaluation and transportation

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Provider/Facility: Amber Waves ALF LLC (878473) Intake ID(s): 3687978 License/Cert. #: AL2324 Investigator: Webster, Brenda Region/Unit:RCS

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X...Residential Care Services Investigation Summary Report Provider/Facility: AWA and Malick Adult Family Home LLC (1133622) Intake ID(s):

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term

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Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X...Statement of Deficiencies Plan of Correction Page 2 of 14 License 750457 MILES ADULT FAMILY HOME Licensee: MILES ADULT AND SENIOR CARE LLC Completion

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] Xfortress.wa.gov/dshs/adsaapps/lookup/RCSForms/AF/751087/inspections/2019/R...Observation and interview occurred on 12/4/18 between 8:45

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated

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lÉâÜ jxww|Çz tà g{x fàA exz|á UÉÜt UÉÜt exáÉÜàassets.stregisborabora.com/lps/assets/u/YourWeddingatT... · 2013-02-28 · the outdoor terrace and private beach. Gracefully

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X...Paradise Care Adult Family Home 2 Licensee: NORMA BALI You are required to be in compliance with all of the licensing laws and regulations

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · (c) Mental health specialty training as described in WAC 388-112A-0450 This requirement was not met as evidenced by: Based on interview

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · The sidewalks on either side of the patio had accumulated about an inch of snow that had not been removed. On 02/08/19 at 1 1 :08

This do cument Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X...During an interview on 12/26/19 at 2:20 PM, Staff A stated that the dresser in Bedroom B had ... there was a large screen television

dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · The Provider stated he had bronchitis but acknowledged and trying to was an issue since admission and the doctor had been notified

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Provider/Facility: Hearthside Manor (699683) Intake ID(s): 3355204 License/Cert. #: AL2142 Investigator: Goulet, Michael Region/Unit:RCS

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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · -Kitchen screen door: was made of fabric-like material with Velcro. The screen door was torn in half and exposed half of the bottom