Residential Care Services Investigation Summary Report

Provider/Facility: AFH ALL SENIOR CARE LLC (914599) Intake ID(s): 3144114

License/Cert. #: AF752940Investigator: Kim, Dahl Region/Unit: RCS Region 2/Unit F Investigation

Date(s):06/20/201606/23/2016

through

Complainant Contact Date(s):Allegations:Husband and wife were live-in caregivers. The wife went to a store to buy bread assuming her husband in the home, but he wasout in the garage. A resident called 911 when he could not find any caregivetrs in the home.

Investigation Methods:Sample: 2 current residents Observations: General care, staff-

resident interactions,staffing and staffavailability

Interviews: Resident and staff Record Reviews: Incident log, incidentinvestigation, measuresto prevent fromreoccurrence, residentand staff records

Allegation Summary:Upon arrival, a caregiver and the entity representative were present in the home. Observation found residents were clean andappropriately dressed. Observed staff-resident interactions were respectful. On interview, one resident stated there's always acaregiver in the house. When interviewed the entity representative (ER) said the incident happened as a result of two live-incaregivers (husband and wife) not directly communicating. A resident who did not see any caregivers when came out to theliving room called 911 and went back to his room. The wife who came up from their living quarters downstairs and didn't see anyresidents in the living room went to a store to buy fresh bread without knowing the 911 call and assuming her husband was inthe house. The husband repaired his car tire in the garage and went to a nearby gas station assuming his wise in the house.Shortly after the police arrived at the home, the husband arrived and so as the wife. The ER and one other caregiver arrivedalmost at the time. This happened within a matter of a few minutes. The ER said she instituted a measure to prevent fromreoccurrence. Record review validated the interview data. Investigation found the home met the minimum licensingrequirements related to the allegations.

Page 1 of 2

Residential Care Services Investigation Summary Report

Unalleged Violation(s):See conclusion

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-76-10265(1)(d) caregiver must have a tuberculosis screening within three days of employment

Page 2 of 2