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Source: WA Dept. of Social & Health Services
Follow-up inspection on 09/19/2024 found no deficiencies; previous deficiencies from compliance determination 35813/47813 are considered corrected.; Program Director (Staff F) cited staff turnover and being overwhelmed as reasons for the failure to keep up with plan documentation and financial oversight.; Plan of Correction data was aggregated from the multiple provided sheets.; Plan of Correction submitted on 10/5/2023 by Michael Vian.
Required documentation for client refusal of health services was not in place for Client 3 and Client 4.
MARs were missing or not accurate.
Lack of adequate nurse delegation process for required client care.
Agency failed to track client cash and gift card purchases.
Agency did not reconcile and verify client cash and gift card accounts.
Individual Instruction and Support Plans (IISP) were not based on current Person-Centered Service Plans (PCSP) for 5 of 5 clients.
Staff performed nursing tasks (applying ointments and eye drops) for Client 5 without proper delegation, training, or written consent.
Provider failed to obtain current Release of Information (ROI) forms for Clients 1, 3, and 4.
Provider failed to reconcile bank account ledgers monthly for Client 2 and Client 5.
Individual Financial Plans (IFP) were not developed or reviewed annually for 4 of 5 clients.
Blocked emergency exits/windows were found for Client 1 and Client 3. Client 1 had mold/mildew in the bathroom and greasy food splatters in the kitchen. Client 3 did not have an accessible flashlight.
IISPs were not available in the homes for Client 1, Client 3, and Client 5.
A $10.00 late fee incurred on a bill paid for Client 3 was not promptly reimbursed.
Release of information forms were not up to date.
Provider failed to ensure prescription labels were on all medication bottles for Client 1.
Lack of proper refusal plans for medical/dental appointments.
Provider failed to ensure necessary follow-up for health services/appointments.
A client was not reimbursed for a late fee paid.
IISPs were not updated or accessible at client homes.
Provider failed to document medications accurately on Client 1's MAR, leading to errors in dose tracking and discontinued medications remaining on records.
Incomplete or missing property records for items of $75 value or more.
Safety issues found including blocked emergency exits/windows in client homes.
Missing current Individual Support Plans (ISP) at client homes.
Medication was delivered without a proper label on the bottle.
Provider failed to maintain current property records for Client 3; items like a TV and AC were not listed.
Provider failed to ensure a DSP completed required 2022 CE training hours.
Provider failed to retain receipts for purchases over $25.00 for Client 2.
Financial plans were outdated or lacked required signatures/details regarding management.
Provider had an outdated background check for a staff member.
Follow-up inspection on 09/30/2024 confirmed no further deficiencies. The agency is closing all operations as of 09/01/2024.
Provider failed to ensure staff were nurse delegated to provide care (wounds, oxygen, medication) before performing tasks, placing client at risk for medical complications.
Provider failed to monitor treatment prescribed by health professionals, including lack of documentation and training for BIPAP, oxygen, and wound care.
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