Residential Care Services Investigation Summary Report

Provider/Facility: NORTH CREEK RETIREMENT &ASSISTED LIVING COMMUNITY(687987)

Intake ID(s): 3446481

License/Cert. #: AL1995Investigator: Bertomeu, Ann Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/17/201710/23/2017

through

Complainant Contact Date(s):Allegations:It was alleged in the assisted living facilty's (ALF) secured memory care unit (SMCU)1) a female resident pushed 3 other female residents

Investigation Methods:Sample: All sampled residents

lived in the SMCUnamed resident (closedrecord)1 sampled resident(closed record)2 sampled residents

Observations: 2 sampled residentsgeneral population

Interviews: 2 sampled residents2 caregivers, SMCU6 MedAides, SMCUResident CareCoordinator (RCC)Registered Nurse (RN)Assistant AdministratorAdministrator

Record Reviews: named resident (closedrecord)1 sampled resident(closed record)2 sampled residentsALF's incident reports andinvestigations

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Residential Care Services Investigation Summary Report

Allegation Summary:Based on observations, interviews and record reviews it was determined the ALF's SMCU;1) acted immediately to ensure the safety of all residents when a female resident became physically aggressive and pushed 3other female residents. The named resident and one sampled resident no longer resided at the ALF's SMCU. Two sampledresidents had no memory of the incident and did not demonstrate fear for their safety in the SMCU.2) During the investigation, it was discovered the named female resident who no longer lived there received medial marijuana.Review of the resident's record and interviews with staff revealed the medical marijuana was not in the form of a capsule/tabletas required by the ALF's Policy on Medical Marijuana. The resident had an authorization, not a written prescription, and therewas no clarification by the naturopathic physician for the strength of the CBD chocolate and/or how it related to the resident'sdiagnosis.This failure placed the named resident at risk for overdose of the medical marijuana and/or unknown side effects which couldimpact the named resident and/or other residents.Failed facility practice identified.

Unalleged Violation(s):Yes. Please see Statement of Deficiencies written 11/06/17

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

WAC 388-78A-2210 (1)(b) Medication Services

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Residential Care Services Investigation Summary Report

Provider/Facility: NORTH CREEK RETIREMENT &ASSISTED LIVING COMMUNITY(687987)

Intake ID(s): 3448022

License/Cert. #: AL1995Investigator: Bertomeu, Ann Region/Unit: RCS Region 2/Unit A Investigation

Date(s):10/02/201710/12/2017

through

Complainant Contact Date(s):Allegations:It was alleged:1) a resident was admitted by the facility, then it was determined the facility could not meet her care needs and family had topay an extra $300.00/day for a private caregiver2) the female resident was given a double dose of her CBD chocolate3) the female resident was receiving Lorazepam and was oversedated, was found lying on the floor because she was so lethargic4) the female resident had not eaten or had anything to drink in 1 to 2 days5) staff were afraid of the resident and did not allow her to leave her roomfor meals and/or activities6) the resident bangs her head against the wall and gets bruises to her forehead and body7) the resident was taken to the hospital for an evaluation and returned to the facility with no identified medical issues

Investigation Methods:Sample: named female resident Observations: named female resident

Interviews: named female residentActivities Director,Secured Memory CareUnit (SMCU)2 caregivers, SMCURegistered NurseAssistant AdministratorAdministrator

Record Reviews: named female resident

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Residential Care Services Investigation Summary Report

Allegation Summary:Based on observations, interviews and record reviews it was determined the assisted living facility/secured memory care unit(ALF/SMCU):1) was aware the resident had aggressive/combative behaviors on admission. The behaviors escalated and the ALF/SMCUassessed the resident as requiring constant 1:1 monitoring I all areas of her life.2) record review found the female resident did not exceed the number of prescribed doses of CBD chocolate3) the resident received Lorazepam, 0.5 mg, once each day on 09/21/17; 09/22/17, 09/25/17 and 09/26/17. The residentpreferred to sit/sleep on the floor of her room because she did not like her bed. The resident was observed to be agitated andaggressive on 10/02/17 while pacing in her room.4) the resident had food and drink available in her room on 10/02/17. She would occasionally walk past the tray and take a biteof food and/or a sip of liquid. Food trays were brought to the resident's room. Staff stated the resident did not come to the diningroom due to disruptive behaviors5) the resident was found on 10/02/17 to be locked in her room. Staff reported, the private caregiver was not there and due tothe resident's aggressive behaviors, she was not allowed to leave her room.6) staff reported the resident had a history of banging her head against the wall. No visible bruises were observed to exposedskin on 10/02/177) the ALF/SMCU sent the resident out for evaluation of a possible medical problem on 09/29/17. The resident returned to thefacility with no abnormal physical findings.

Unalleged Violation(s):None

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Citations writtenWAC 388-78A-2660 (1) Resident's Rights; RCW 70.129-130 (1)Abuse, punishment, seclusionWAC 388-78A-2600 (2)(g)(j)(i)(ii )(iii) Policies and ProceduresWAC 388-78A-2140 (5) Negotiated Service Agreement Contents

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