Residential Care Services Investigation Summary Report

Provider/Facility: SOSSI ADULT FAMILY HOME (687529) Intake ID(s): 3220857

License/Cert. #: AF690101Investigator: Swanstrom, Shawn Region/Unit: RCS Region 3/Unit E Investigation

Date(s):06/03/201606/03/2016

through

Complainant Contact Date(s): 06/03/2016, 06/13/2016Allegations:# 1 - There are unqualified caregivers working at the home.

Investigation Methods:Sample: 3 current residents and 1

closed recordObservations: General environment,

general appearance ofresidents, residentrooms, and staff-to-resident interaction.

Interviews: Sampled residents, theprovider, and thecaregiver.

Record Reviews: # 1- Two of two sampledcaregiver file reviewsrevealed both caregiverswere unqualified to workalone at the home.

Allegation Summary:WAC 388-76-10135 - Caregiver qualifications was identified as failed practice. Please refer to the Statement of Deficienciesdated 6/3/2016.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-76-10135 - Caregiver qualifications was identified as failed practice. Please refer to the Statement of Deficienciesdated 6/3/2016.

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