Residential Care Services Investigation Summary Report

Provider/Facility: Ponderosa Care Center (686621) Intake ID(s): 3321937

License/Cert. #: AF193500Investigator: Solomon, Brooke Region/Unit: RCS Region 1/Unit B Investigation

Date(s):03/14/201703/14/2017

through

Complainant Contact Date(s):Allegations:1. The adult family home was overdue on their annual licensing fee.

Investigation Methods:Sample: 5 current residents Observations: resident condition, care

supplies, food storage,utilities/water,environment

Interviews: residents, staff, provider Record Reviews: annual license feepayment history

Allegation Summary:1. Residents were observed in the home to receive care and services from staff. The home had running water, electricity, andwas an appropriate temperature. Hygiene and food supplies were available to meet resident's needs. Per resident interviews,there were no concerns related to care/services at that time. According to the provider, she had not paid the annual license feedue to an oversight, and would pay by the following month.

Unalleged Violation(s): Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

A citation was written related to license annual fee, WAC 388-76-10025(1)(2)(3)(4). The citation may be found on the Statementof Deficiencies dated March 14, 2017.

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