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Residential Care Services Investigation Summary Report
Provider/Facility: Blossom Place (768926) Intake ID(s): 3270601
License/Cert. #: AL2190Investigator: THOMPSON, HERMELINDA Region/Unit: RCS Region 1/Unit D Investigation
Date(s):10/18/201610/20/2016
through
Complainant Contact Date(s):Allegations:The named resident left the facility without staff's awareness and walked off the property.
Investigation Methods:Sample: Named resident and two
additional sampledresidents.
Observations: General environment,location of store wherenamed resident waspicked up from, facilityfront entrance/exit doorand locking/alarmingmechanism, residentappearance, staff toresident interactions,activities in facility.
Interviews: All sampled residents,family member,Concierge, CommunityRelations Director,Maintenance Director,caregivers, housekeeper,Nursing Director andExecutive Director.
Record Reviews: Reviewed the facilitypolicy on elopements,accidents/investigations.Reviewed all sampledresident medical records,including NegotiatedService Agreements,Physician Orders, carenotes, MedicationAdministration Records,assessments andinvestigations directlyrelated to allegations.
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Residential Care Services Investigation Summary Report
Allegation Summary:The facility received a call from a family member that named resident was at an auto parts store approximately half a mile fromthe facility. Facility staff was looking for the named resident at the time. The facility identified issues with the front doorrestricted egress keypad and locking/alarm mechanism at least one month prior to incident. The facility staff did not complete afocused assessment immediately after the incident to determine the named resident's physical/emotional condition related tothe incident. The facility did not thoroughly investigate the incident and the physician was contacted approximately three weeksafter. There were no safety measures put in place to assure the resident was safe until approximately three weeks after theincident.
Unalleged Violation(s): Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
Cited 388-78A-2100(2)(a)Cited 388-78A-2700(2)(c)(i)(ii)(iii)
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Residential Care Services Investigation Summary Report
Provider/Facility: Blossom Place (768926) Intake ID(s): 3278499
License/Cert. #: AL2190Investigator: THOMPSON, HERMELINDA Region/Unit: RCS Region 1/Unit D Investigation
Date(s):10/18/201610/20/2016
through
Complainant Contact Date(s): 10/10/2016, 10/21/2016Allegations:AV put down a large deposit at facility but chose not to become a resident; money had not been refunded to AV.
Investigation Methods:Sample: AV and three additional
discharged residents.Observations: General environment.
Interviews: AV, Concierge,Community RelationsDirector, caregiver,Nursing Director andExecutive Director.
Record Reviews: Facility admissionagreement, whichincluded resident rightsinformation. Financialreceipts and checkwritten by AV. Financialrecord of three additionaldischarged residents,with review of financialreceipt of pending refundfor one of the closedrecords.
Allegation Summary:The facility did not follow through with the facility process to determine that the AV had not moved in and was due a refund ofthe submitted deposit.
Unalleged Violation(s): Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
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Residential Care Services Investigation Summary Report
Cited 388-78A-2660 with reference to 70.129.150.1
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