Residential Care Services Investigation Summary Report

Provider/Facility: PEACE N COMFORT (687952) Intake ID(s): 3248743

License/Cert. #: AF750472Investigator: Singer, Jamie Region/Unit: RCS Region 2/Unit E Investigation

Date(s):10/13/201610/20/2016

through

Complainant Contact Date(s): 10/12/2016, 10/14/2016Allegations:#1. The adult family home (AFH) had only one caregiver on duty when the Named Resident (NR) had an unwitnessed fall.

Investigation Methods:Sample: Residents Observations: Environment, Resident

Care, Meal PreparationInterviews: Residents, Provider, Staff Record Reviews: Resident Records,

Incident Log, AFH policiesand procedures

Allegation Summary:#1. Review of the NR's assessment by a qualified assessor did not designate the NR required two caregivers to provide care.The AFH had realistic fall prevention and safety plan in place for the NR.

Unalleged Violation(s):See Statement of Deficiencies dated 10/20/2016.

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

See Statement of Deficiencies dated 10/20/2016.

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