Examples of enforcement letters to Adult Family Homes certified to care for people with Developmental Disabilities in Washington State

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1 Examples of enforcement letters to Adult Family Homes certified to care for people with Developmental Disabilities in Washington State Repeated, uncorrected violations highlighted All information retrieved from Adult Family Home Locator DSHS Website February 12, 2013

2 Adult Family Home A. Feb 9, 2011 ( The following are all from one provider) 1. WAC (1) License-Ability to provide care and services. The provider had been unable or unwilling to follow minimum licensing requirements required of the licensed adult family home providers. 2. WAC (1)(2) Assessment--Updates required. The provider failed to ensure 2 residents' assessment reflected significant changes when the resident was newly diagnosed with adult onset diabetes mellitus (Type 2). This placed the resident at risk for not receiving vital diabetic care and services. The resident had improved significantly, but her assessment was not updated. This placed her at risk for not receiving the care she now required. This is a repeat or uncorrected deficiency, previously cited on July 15, WAC (1)(2) Negotiated care plan--timing of reviews and revisions. The provider failed to ensure diabetic care and services were included on 1 residents' negotiated care plan. This placed the resident at risk for not receiving vital care and service. 4. WAC (2) Care and services. The provider failed to ensure two residents received the care and services they required. This is a repeat or uncorrected deficiency, previously cited on July 15, WAC (1)(a)(b)(i)(2)(a)(b)(c)(3)(a)(b) Medication--Assessment-- Identification of amount of assistance needed when taking medications. The Provider failed to ensure two residents were assessed for independent self administration of their medications. This placed two residents at risk of not receiving their medications as prescribed by their physicians. 6. WAC (1) Medication organizers. The provider failed to ensure two residents medication organizers were filled by the pharmacist, family member, or a licensed nurse. This placed these residents at risk for medication errors 7. WAC (4)(a)(b)(c)(d) Medication organizers. The provider failed to ensure two residents medication organizers were labeled incorrectly to include the name of the resident, the name, frequency and dose of the medications. This placed these residents at risk for receiving the wrong medications.

3 Adult Family Home A Continued: 8. WAC (1)(3) Medication storage. The provider failed to ensure medications were secured in locked storage for three residents in their bedrooms, the kitchen refrigerator, and the kitchen cupboard. This placed five cognitively impaired mobile residents at risk for using medications not prescribed by their practitioner. 9. WAC (1)(2)(3) Medical devices. The provider failed to ensure one resident had a safety assessment for the use of a side rail, that the side rail was included in the negotiated care plan, and that enough information about the risks of using a side rail was given to make an informed decision. This placed one resident at risk for harm and/or entrapment. Adult Family Home B. Jan 24, WAC (1)(2)(c)(d)(3) Medication system. $ The provider failed to ensure one resident received medication assistance from the staff as required. This is a repeat and/or uncorrected deficiency from September 27, 2012 and November 30, WAC (1)(2)(c)(d)(e) Medication log. $ The provider failed to ensure the daily medication logs for one resident was updated when there were changes. This is a repeat and/or uncorrected deficiency from September 27, 2012 and November 30, WAC (5) Medication organizers. $ The provider failed to update the label on the medication organizers 4. WAC (1) Medication storage. $ The provider failed to ensure all medications were kept in locked storage. This is a repeat and/or uncorrected deficiency from November 30, WAC (1)(2)(c)(d)(3) Medication system. The provider failed to ensure one resident received medication assistance from the staff as required. This is a repeat and/or uncorrected deficiency from September 27, 2012 and November 30, 2012.

4 Adult Family Home C April 6, WAC (1)(a)(f) Qualifications-Adult family home personnel./wac (1)(3) Who is required to complete continuing education training, and when? The Co-providers failed to ensure food safety training was completed in calendar year 2010 by three caregivers. Additionally, one staff did not complete any continuing education hours for calendar year These failures placed the residents at risk for care received from unqualified staff. This is a repeat or uncorrected deficiency previously cited on September 10, WAC (2)(d) Adult family home-personnel records. The Co-providers failed to ensure documentation of HIV/AIDS training was accessible to authorized department staff for two caregivers as required. 3. WAC (1-3) (4)(b)(5)(6)(a-c)(7)(10)(11)(a-h)(12)(a-c)(13) Resident assessment topics. The Co-providers failed to obtain a comprehensive written assessment by a qualified assessor before the non-emergent admission of one resident. This failure placed the resident at risk for unidentified care and service needs not being met by the home s staff. 4. WAC (1)(4) Assessment-Updates required. The Co-providers failed to ensure the assessments were reviewed and updated as required for two residents. These failures placed the residents at risk for care and service needs not being identified and met. This is a repeat or uncorrected deficiency previously cited on October 27, WAC (1-3)(7)(b)(c)(8) Negotiated care plan. The Co-providers failed to ensure negotiated care plans addressed care to be provided for each residents needs for four residents who had lived in the home more than thirty days. These failures placed the residents at risk for care and service needs not being met. This is a repeat or uncorrected deficiency previously cited on November 17, WAC (2)(4) Negotiated care plan-timing of reviews and revisions. The Co-providers failed to ensure the negotiated care plan was updated to include wound care for one resident who had a change of condition. This failure placed the resident at risk for care and service needs not being met. This is a repeat or uncorrected deficiency previously cited on September 9, WAC (3)(a)(b)(4) Care and services. The Co-providers failed to ensure resident safety and quality of life was supported for two residents when one resident developed contractures and pressure sores and when no accommodation was made for socialization for another resident. These failures may have led to development of pressure ulcers and hip joint deformities for one resident and emotional distress for one resident to be isolated and lonely. This is a repeat or uncorrected deficiency previously cited on September 9, 2008.

5 Adult Family Home C continued 8. WAC (4) Meals and snacks. The Co-providers failed to obtain written physician approval before serving a liquid nutrition to one resident who received the product. This failure placed the resident at risk for harm if the resident was not able to satisfactorily tolerate the supplement 9.WAC (1)(2)(b)(3)(c)(i)(ii)(iv) Medication-Log. The Co-providers failed to ensure daily medication logs were kept current, documented prescription changes as required, obtained written verification of changes, and logged all medications by their names for two residents. These failures placed the residents at risk for medication errors. 10. WAC (1) Medication storage. The Co-providers failed to have a system in place to ensure all prescription and over the counter medications were kept in locked storage. These medications were accessible to four ambulatory residents and to visitors in the home. 11. WAC (1)(2) Medication disposal-written policy-required. The Co-providers failed to implement the home s medication disposal policy when medications were not disposed of after a resident left the home and when medications were expired and placed five residents at risk for medication errors. 12. WAC (1-3) Medical devices. The Co-providers failed to ensure two residents were assessed as needing bed rails, were informed of the safety risks, and care planning documented for use of the device. These failures placed the residents at risk for serious injury or death from entrapment in devices they may not have needed. 13. WAC Staff behavior related to abuse. The Co-providers failed to ensure one resident, who was unable to get out of her room independently, was regularly brought out of her bedroom into the presence of others in the home. This failure cause a violation of the resident s right to be free of involuntary seclusion in her room and may have contributed to an acceleration of her cognitive decline. 14. WAC (2)(b) Bedrooms. The Co-providers failed to ensure windows were screened in bedrooms occupied by three residents. This failure placed the three residents living in the rooms at risk for discomfort due to bites from flying insects and other vermin entering their rooms. 15. WAC (11) Bedrooms. The Co-providers failed to ensure a call bell or system was available to four residents who were able to use such a device. This failure placed the residents at risk for care needs not being met at night or other times when staff was not physically present in the adult family home area of the residence. 16. WAC (1) Safety and maintenance. The Co-providers failed to ensure interior and exterior portions of the home were kept in a safe, sanitary, comfortable, and homelike condition and placed five residents at risk for diminished quality of life and possible injury. This is a repeat or uncorrected deficiency previously cited on June 26, 2007.

6 17.WAC (5)(a-c) Safety and maintenance. The Co-providers failed to have a system in place to ensure the water temperature a the lower level kitchen sink did not exceed one hundred twenty degrees Fahrenheit and placed four ambulatory residents at risk for injury from scalding. This is a repeat or uncorrected deficiency previously cited on September 10, WAC (6) Safety and maintenance. The Co-providers failed to ensure all toxic cleaning products were kept inaccessible to four residents who were not assessed as safe to use the products without supervision. This failure placed the residents for inappropriate use of the material. 19. WAC (2) Emergency drinking water supply. The Co-providers failed to have at least three gallons of drinking water designated for emergency use on site for each resident and household member and placed five residents at isk for dehydration had an emergency occurred and insufficient drinking water available. This is a repeat or uncorrected deficiency previously cited on October 24, WAC (1) Posting the emergency evacuation floor plan-required. The Co-providers failed to ensure an emergency evacuation floor plan was posted on the upper level of the adult family home and placed five residents at risk if their caregivers were on the upper level of the home when an emergency occurred. Sept 14, 2011 CONTINUED OUT OF COMPLIANCE Last enforcement letter on this home what happened after that? Adult Family Home D Dec 11, (1)(2)(3)(b) Care and services. Res. #1=$3,000.00, Res. #2, #3, and #4 $ x 3 residents = $1, Total =$4, The home failed to provide the necessary care and services for one resident who had surgery and began to bleed from the surgical site and failed to provide the needed supervision for three residents who had histories of wandering or exit seeking and the residents were left unattended in the home. This failure resulted in one resident exiting the home to seek emergency care and placed three other residents at risk for exiting the home also or from falls and injuries while wandering in the home. This is a repeat or uncorrected deficiency previously cited on July 12, 2011 and September 7, 2011.

7 Adult Family Home D continued: 2. WAC (2)(b) License requirements-qualified person must live in or be on site. The home failed to ensure a qualified staff member was in the home at all times. This failure placed all residents at risk for needs going unmet and injuries due to wandering or exiting the home. 3. WAC (1)(2) Incident log. The home failed to ensure the incident log was updated to include an incident when one resident left the home seeking help. 4. WAC (1)(2)(3)(b) Care and services. The home failed to provide the necessary care and services for one resident who had surgery and began to bleed from the surgical site and failed to provide the needed supervision for three residents who had histories of wandering or exit seeking and the residents were left unattended in the home. This failure resulted in one resident exiting the home to seek emergency care and placed three other residents at risk for exiting the home also or from falls and injuries while wandering in the home. This is a repeat or uncorrected deficiency previously cited on July 12, 2011 and September Adult Family Home E July 12, 2012 STOP PLACEMENT OF ADMISSIONS AND REVOCATION OF LICENSE CONTINUED CONDITIONS ON A LICENSE 1.WAC (1) License Ability to provide care and services. The entity representative lacked the understanding necessary to protect vulnerable adults from abuse and neglect. 2. WAC (1)(2)(3)(4) Prevention of abuse. The facility failed to protect six residents from the threat of sexual abuse by allowing the Resident Manager (RM), who was under police investigation for inappropriate sexual contact towards a resident, entrance into the AFH following instruction from law enforcement to keep the RM from entering the AFH. Adult Family Home F May 22, WAC (10(2)(c)(d)(3) Medication system. The facility failed to ensure a safe medication delivery system was in place. 2. WAC (1)(2) Medication Administration. The facility failed to ensure consents for nurse delegation were obtained from the resident/representative, failed to follow verbal instructions, failed to ensure one caregiver was instructed on nurse delegation, and failed to ensure written documentation received included specific instructions.

8 Adult Family Home F Continued: Feb 6, WAC (3) Background checks. $50.00 The facility failed to ensure provider s family member has a background check. This is a repeat deficiency previously cited on April 25, WAC (1) Food services. $ WAC (3) Who is required to complete continuing education training, and when? $50.00 The facility failed to ensure a staff and the provider s family member completed required safe food handling training. This is a repeat deficiency previously cited on April 25, WAC (1)(2)(c)(d)(3) Medication system. $ The facility failed to ensure a medication administration system was in place to meet the needs of four residents. This is a repeat deficiency previously cited on September 9, 2010, April 25, 2012, and August 25, Adult Family Home G Feb 28, WAC (2) Negotiated care plan-timing of reviews and revisions. The home failed to update a negotiated care plan for one resident. Failure to update the negotiated care plan placed the resident at risk for injury due to his unsafe behavior. 2. WAC (3)(b) Care and services. The home failed to ensure the monitoring and safety of one resident when the resident trespassed onto a neighbor s property on two occasions; once during the day and five weeks later, at night. This failure placed the resident at risk for injury. July 3, WAC (14)(a) Remedies-Department may impose remedies./wac (6) Informal dispute resolution. $2, The adult family home failed to comply with a condition imposed on its license. This is a repeat or uncorrected deficiency previously cited on April 6, 2012.

9 Adult Family Home G Continued July 26, WAC (2)(c) Reporting requirement. $2, The adult family home failed to notify emergency services when one resident had two seizures. Adult Family Home H Jan 11, WAC (2) License Ability to provide care and services. $ The Licensee failed to meet business financial obligations by not paying the light bill in a timely manner. This failure caused the electricity at the adult family home to be turned off on November 3, 2010 for four to five hours causing inconvenience and discomfort for residents. July 14, WAC Background checks. $100 The licensee failed to ensure staff background checks on file were valid. This is an uncorrected violation from February 23, WAC Staff records. $100 The licensee failed to ensure staff records were accessible. This is an uncorrected violation from February 23, WAC Medication Administration. $100. The licensee failed to medication was administered per nurse delegation. This is an uncorrected violation from February 23, All information retrieved from Adult Family Home Locator DSHS Website

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