Residential Care Services Investigation Summary Report

Provider/Facility: ADAGIO ADULT FAMILY HOME(688183)

Intake ID(s): 3445040

License/Cert. #: AF750846Investigator: Dolin, Dorothy Region/Unit: RCS Region 2/Unit B Investigation

Date(s):09/26/201709/28/2017

through

Complainant Contact Date(s):Allegations:Failure to contact resident's family and medical profession when the resident had a significant health change.

Investigation Methods:Sample: no sample Observations: no observations

Interviews: interviews with providers,nurse delegator andresident's health caremedical doctor

Record Reviews: reviewed Resident #1records

Allegation Summary:provider failed to contact health care provider and family when Resident 1 had significant health changes

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Citation written under WAC 388-76-10225 reporting requirement

Page 1 of 1