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Inspection Detail
Case Status: CLOSED
Inspection: 1517267.015 - Wa317962749 - Nds Adult Family Home Inc
Inspection Information - Office: Dosh Seattle Service Location, Seattle, Wa
Inspection Nr: 1517267.015
Report ID: 1055320
Date Opened: 02/16/2021
Site Address:
Wa317962749 - Nds Adult Family Home Inc
1635 S. 244th Pl
Des Moines, WA 98198
Mailing Address:
2123 S 248th St Bldg 1, Kent, WA 98032
Union Status: NonUnion
SIC:
NAICS: 623312/Homes for the Elderly
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Health
Close Conference: 04/08/2021
Emphasis:
Case Closed: 11/29/2021
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1733580 |
Case Status: CLOSED
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 3 | 2 | 5 | |||
| Current Violations | 3 | 2 | 5 | |||
| Initial Penalty | $7,500 | $0 | $0 | $0 | $0 | $7,500 |
| Current Penalty | $7,500 | $0 | $0 | $0 | $0 | $7,500 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Serious | 296-842-13005 | 04/23/2021 | 03/16/2021 | $2,500 | $2,500 | $0 | Z - Issued | ||
| 2. | 01002 | Serious | 296-842-12005(1) | 04/23/2021 | 05/26/2021 | $2,500 | $2,500 | $0 | Z - Issued | ||
| 3. | 01003 | Serious | 296-842-15005(1)(A) | 04/23/2021 | 05/26/2021 | $2,500 | $2,500 | $0 | Z - Issued | ||
| 4. | 02001 | Other | 296-842-14005 | 04/23/2021 | 05/26/2021 | $0 | $0 | $0 | Z - Issued | ||
| 5. | 02002 | Other | 296-27-031(1) | 04/23/2021 | 03/16/2021 | $0 | $0 | $0 | Z - Issued |
Investigation Summary
Investigation Nr: 134362.015
Event: 12/28/2020
Employee with COVID-19 infection dies
An employee was working as a certified nurses assistant worked at an adult family home when she contracted COVID-19 on December 3, 2020. The employee was admitted to a local medical center and died due to COVID-19 on December 28, 2020.
Keywords: Infectious Disease
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1517267.015 | 67 | F | Fatality | Occupation not reported |