Dshs adult family home incident log
WebDEPARTMENT OF SOCIAL AND HEAL TH SERVICES DSHS/ALTSNRCS AGING AND LONG-TERM SUPPORT ADMINISTRATION Statement of Deficiencies Plan of Correction Page I of 2 20425 72nd Avenue S, Suite 400, Kent, WA 98032-2388 License#: 752636 CONTENTMENT ADULT FAMILY HOME LLC Licensee: CONTENTMENT ADULT … WebMake sure the details you fill in Adult Family Home Incident Log - DSHS - Dshs Wa is up-to-date and accurate. Indicate the date to the form using the Date tool. Select the Sign tool and make an electronic signature. You can find three available alternatives; typing, drawing, or uploading one. Re-check every area has been filled in properly.
Dshs adult family home incident log
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WebResidential Care Services Online Incident Reporting Online Incident Report Reporter/Fac. Information Involved Individuals Incident Details Verify & Submit Online Incident Report * Incident Report Type: Reporter Information * First Name: * Last Name: * Job Title: Callback Number: Facility Information * Facility/Agency Type: * License/Cert. Number: WebDescribe any injuries as a result of this incident, who was injured, and type and location of injury: Is abuse, neglect, personal or financial exploitation, abandonment, or improper restraint suspected? ... Brombacher, Millie A. (DSHS/IGU) Created Date: 09/16/2024 09:26:00 Title: Incident Report to DDA Last modified by:
WebAnnouncements. Liability insurance is required in all adult family homes by WACs 388-76-10191 through 388-76-10193. We are hearing that some homes are finding it difficult to obtain and maintain liability insurance upon licensure. Some insurance companies have implemented training and experience requirements above and beyond what is required … WebINCIDENT REPORT FORM. Please direct any questions to Steve Cazel at (360) 725–3706 or [email protected]. DBHR Internal Form/IR_CatronC_8/2010. Page 1 of 1
WebFire Safety & Emergency Drills Form. WAC 110-300-0470 (4) requires family home providers and child care center providers to use this DCYF form. School-age providers may use this form, but WAC 110-305 does not require use of this specific form. DCYF #15-892 Fire, Safety, Emergency Drills Record. WebAdult Residential Care (ARC) services are provided by licensed Assisted Living Facilities that have an Adult Residential Care contract with the Aging and Long-Term Support Administration (ALTSA). Services provided include housing, housekeeping services, meals, snacks, laundry, personal care, and activities. Additional Information:
WebDSHS Forms Enforcement Video Notice of Transfer or Discharge (DSHS 10-237) Opioid Abuse: Facts & Prevention Tips Request for an Administrative Hearing (DSHS 10-238) Nursing Home Information Changes (DSHS 10-603) Electronic Plan of Correction (ePOC) Emergency Preparedness CMS Emergency Preparedness Checklist (12/2013) …
WebEmergency Planning Information. ICF-IID Response to Natural or Human-Made Disaster. CMS Information and Status Reports Information Status Reports During & After. Flu Information. Department of Health. Centers for Disease Control and Prevention. Adult Immunization Resources. ICF/IID Information Changes Form (DSHS 10-605) ICF/IID … how many greater one horned rhinos are lefthow 2 hide a bodyWebI want to file a complaint against an adult family home, nursing home or assisted living facility. Who do I contact? Some facilities, such as nursing homes and assisted living facilities, are regulated by the Department of Social and Health Services (DSHS). You can file a complaint with DSHS by calling 800-562-6078. how 2 hoer huglightWebOur mission is to promote and protect the rights, security and well being of individuals living in these licensed or certified residential settings. Make an Online Incident Report Management Bulletins Provider Letters Contact Us Facility Information Adult Family Home Providers Assisted Living Providers Nursing Home Professionals how many great grandfathers do i haveWebCall the DSHS Complaint Hotline (1-800-562-6078) and report your concern. You will be asked to leave a message. Provide specific details about your concern, your name and phone number, and a good time to reach you. DSHS will call you back. You also have the option to remain anonymous to the facility, DSHS, or to both entities. how many great danes are thereWebINSTRUCTIONS: Provider, Resident Manager, or caregiver completes a log entry whenever there is an injury or accident involving a resident. Keep this log in the Adult Family Home in a readily accessible area. PROVIDER’S NAME STREET ADDRESS CITY. DATE NAME OF RESIDENT. NATURE OF INJURY OR ACCIDENT. how many great flood legends have been foundWebResidential Care Services Adult Family Home Providers AFH Information AFH Information This series has been developed with the prospective provider in mind, but will also assist the general reader in understanding the basics of adult family home operation. Extended information is available on specific related topics. how many great grandparents chart