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Residential Care Services Investigation Summary Report
Provider/Facility: Cherry Blossom Home Care in KentLLC (1004951)
Intake ID(s): 3460759
License/Cert. #: AF753230Investigator: Osterman, Pamela Region/Unit: RCS Region 2/Unit G Investigation
Date(s):12/06/201712/22/2017
through
Complainant Contact Date(s): 12/05/2017Allegations:#1. The adult family home caregiver is stealing money from the named resident (NR) and will not allow the NR to see the bankaccount.
Investigation Methods:Sample: residents (including
named resident)Observations: AFH: caregiver/resident
interactionInterviews: current resident's
caregiverprovider
Record Reviews: AFH: negotiated care plan(NCP), staff backgroundcheck, abuse policy, NRbanking recordsassessment
Allegation Summary:#1. On AFH tour observed caregiver/resident interaction appropriate. Two resident's said they are well cared for by AFH staffand have not had had money stolen. Named resident said wasn't sure if anyone was taking their money. The provider andthe caregiver said NR did not tell them NR was any missing money. The provider said NR manages money independent.Record showed NR had bank records to look at. The provider said NR cashed a check and put money in an envelop under sheetof bed. The caregiver said they changed linen and saw the envelop on the sheet. The provider asked NR where NR's money wasand when shown it was less than provider thought should be. The provider asked the caregivers if they took NR's money andthey said, "No". The provider fired one caregiver due to "suspicious" about stealing NR's money. Then provider said they did notreport the incident or suspicious caregiver. Record showed the NCP/assessment were up to date. Record showed the AFH had anadequate abuse policy. Record showed NR's bank record copies in NR's personal file. Record of staff background checks had nocriminal record.
Unalleged Violation(s): Yes No
Page 1 of 2
Residential Care Services Investigation Summary Report
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
See statement of deficiencies dated 12-22-17.
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Residential Care Services Investigation Summary Report
Provider/Facility: Cherry Blossom Home Care in KentLLC (1004951)
Intake ID(s): 3472603
License/Cert. #: AF753230Investigator: Osterman, Pamela Region/Unit: RCS Region 2/Unit G Investigation
Date(s):12/06/201712/22/2017
through
Complainant Contact Date(s):Allegations:#1. Named resident is being physically abused.
#2. Named resident had radio and power pack stolen.
#3. Named resident can not have friend come over with
Investigation Methods:Sample: residents (including
named resident)Observations: AFH: caregiver/resident
interactionInterviews: current resident's
caregiverprovider
Record Reviews: AFH: negotiated care plan(NCP), NR belonging list,staff background checkassessment
Allegation Summary:#1. On AFH tour observed caregiver/resident interaction appropriate. Two current residents said they are well cared for by AFHstaff, felt safe and, have not had personal items stolen from the home. Named resident (NR) said "No" when asked if anyone washurting them and said "they are good to me and, they feed me well." The provider and two caregivers said NR is not abused inthe home.#2. NR said the radio in the room is not NRs "the radio and power pack disappeared." The provider and two caregivers said havenot seen a radio and power pack Record showed no radio and power pack brought into the home with NR.3 NR said "they don't let me that is the problem". The provider said there is a AFH policy and removed two
from NRs jacket. Record showed the NCP/assessment were up to date. Record showed the AFH had an adequateabuse policy. Record of staff background checks had no criminal record.
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Residential Care Services Investigation Summary Report
Unalleged Violation(s):The AFH failed to report the suspect for the NR financial exploration to the department hot line, law enforcement andDepartment of health.
Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
See statement of deficiency dated 12/22/2017.
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Residential Care Services Investigation Summary Report
Provider/Facility: Cherry Blossom Home Care in KentLLC (1004951)
Intake ID(s): 3476214
License/Cert. #: AF753230Investigator: Osterman, Pamela Region/Unit: RCS Region 2/Unit G Investigation
Date(s):12/06/201712/22/2017
through
Complainant Contact Date(s):Allegations:#1. Named resident fell out of wheelchair. 911 was called, NR went to the emergency room for and abrasions.
Investigation Methods:Sample: residents (including
named resident)Observations: AFH: caregiver/resident
interactionInterviews: current resident's
caregiverprovider
Record Reviews: AFH: negotiated care plan(NCP), staff backgroundcheck, incident logassessment
Allegation Summary:#1. On AFH tour observed caregiver/resident interaction appropriate. Two residents said they are well cared for by AFH staffand, felt safe living in the home. Named resident said they were going down the ramp in when fell over at thebottom of ramp.Caregiver said they asked NR to wait while caregiver got a jacket. NR said they have a bad memory and did not wait forcaregiver.Caregiver said they found NR with bleeding at end of ramp Caregiver said they called 911 and NR went to the hospitalreturning the same day. Provider said NR had abrasions to and Hospital record showed x-rays done and nofurther injuries. Observed healing and abrasions on NR. Record showed NCP/assessment are up to date. Recordshowed staff background checks had no criminal record. Record showed the incident was logged and reported.
Unalleged Violation(s):The AFH failed to report the suspect for the NR financial exploration to the department hot line, law enforcement andDepartment of health.
Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
Page 1 of 2
Residential Care Services Investigation Summary Report
See statement of deficiency dated 12/22/2017.
Page 2 of 2
