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![Page 1: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/1.jpg)
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![Page 2: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/2.jpg)
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![Page 3: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/3.jpg)
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![Page 4: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/4.jpg)
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![Page 5: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/5.jpg)
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![Page 6: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/6.jpg)
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![Page 7: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/7.jpg)
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![Page 8: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/8.jpg)
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![Page 9: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/9.jpg)
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![Page 10: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/10.jpg)
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![Page 11: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Licensee: WRG PHASE 1 Completion Date October 16, 2017 Per WAC (Washington Administrative Code) 388-112-0207(1), all long-term](https://reader033.pdfslide.net/reader033/viewer/2022050503/5f95c3b7b7adb175565453cb/html5/thumbnails/11.jpg)
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![dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Provider/Facility: Hearthside Manor (699683) Intake ID(s): 3355204 License/Cert. #: AL2142 Investigator: Goulet, Michael Region/Unit:RCS](https://img.pdfslide.net/doc/110x75/5f5e99d369caaa3bb249a8b5/dz-u-v-z-v-o-z-x-providerfacility-hearthside.jpg)
![dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted](https://img.pdfslide.net/doc/110x75/5f466ce759440939a253af98/dz-u-v-z-v-o-z-x-residential-care-services-investigation.jpg)
![dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019-08-22 · Record review revealed Volunteer A had a Washington State Name and Date of Birth background check and no documentation](https://img.pdfslide.net/doc/110x75/5e97d609a66c2c2b6a093006/dz-u-v-z-v-o-z-x-2019-08-22-record-review-revealed.jpg)
![dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · 2019-10-15 · DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, suite 400,](https://img.pdfslide.net/doc/110x75/5f0bd4327e708231d4326a71/dz-u-v-z-v-o-z-x-2019-10-15-department-of-social.jpg)
![dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · qualifications. Allegation Summary: 1) Prior to fall, Named Resident recognized need to toilet and walked with and without assistive](https://img.pdfslide.net/doc/110x75/5fc894a945c1280ccc361461/dz-u-v-z-v-o-z-x-qualifications-allegation-summary.jpg)
![dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] Xfortress.wa.gov/dshs/adsaapps/lookup/RCSForms/AF/751087/inspections/2019/R...Observation and interview occurred on 12/4/18 between 8:45](https://img.pdfslide.net/doc/110x75/5fa827be9f02aa4bcd165d8e/dz-u-v-z-v-o-z-observation-and-interview.jpg)
