Lighthouse Memory Care.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 LIGHTHOUSE MEMORY CARE LLC LIGHTHOUSE MEMORY CARE 3502 KAVENUE ANACORTES, WA 98221 RE: LIGHTHOUSE MEMORY CARE License# 2204 Dear Administrator: This letter addresses Compliance Determination(s) 66236 (Completion Date 09/26/2025) and 63220 (Completion Date 07/30/2025). The Department completed a follow-up inspection of your Assisted Living Facility on 09/26/2025 and found no deficiencies. Your facility meets the Assisted Living Facility licensing requirements. The Department found that deficiencies for the following licensing laws and regulations were corrected: WAC 388-78A-2474-2-d, WAC 388-78A-2466-1-a, WAC 388-78A-3100-1, WAC 388-78A-3100- 2 The Department staff who did the on-site verification: Karen Glover, Nursing Consultant Institutional Cristina Gonzalez, Nursing Consultant Institutional Melissa Phillips, Long Term Care Surveyor If you have any questions, please contact me at (253)312-1446. Sincerely, . s· r Jamie"S"..i.n,-,gc~er, Field Region 2, Unit J Residential Care Services This document was prepared by Residential Care Services for the Locator website. ST ATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 3906-172nd St NE, Suite #100, Arlington, WA 98223 Statement of Deficiencies License #: 2204 Compliance Determination # 63220 Plan of Correction LIGHTHOUSE MEMORY CARE Completion Date Page 1 of6 Licensee: LIGHTHOUSE MEMORY CARE LLC 07/30/2025 You are required to be in compliance at all times with all licensing laws and regulations to maintain your Assisted Living Facility license. The department completed data collection for the unannounced on-site full inspection on 07/28/2025 and 07/29/2025 of: LIGHTHOUSE MEMORY CARE 3502 KAVENUE ANACORTES, WA 98221 The following sample was selected for review during the unannounced on-site visit: 7 of 31 current residents and O former residents. The department staff that inspected the Assisted Living Facility: Melissa Phillips, Long Term Care Surveyor Cristina Gonzalez, Nursing Consultant Institutional Karen Glover, Nursing Consultant Institutional From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit A 3906-172nd St NE, Suite #100 Arlington, WA 98223 This document was prepared by Residential Care Services for the Locator website. 08.05.2025 09:24:17 State of Washington 6/15 Statement of Deficiencies License #: 2204 Compliance Determination # 63220 Plan of Correction LIGHTHOUSE MEMORY CARE Completion Date Page 2 of6 Licensee: LIGHTHOUSE MEMORY CARE LLC 07/30/2025 As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. i~t / t~: l ~'") (1 t~:_ -~~~; \.,.} f ~-} ! .~:. . \)~ .«t~..: ~-.l Residential Care Services Date I understand that to maintain an Assisted Living Facility license. the facility must be in compliance with all the licensing laws and regulations at all times. Laaw--W~ 8/6/2025 Administrator ( or Reprsentative) Date WAC 388-78A-2474 Training and home care aide certification requirements. (2) The assisted living facility must ensure all assisted living facility administrators, or their designees, and caregivers hired on or after January 7, 2012 meet the long-term care worker training requirements of chapter 388-112A WAC, including but not limited to (d) Cardiopulmonary resuscitation and first aid; and This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure staff completed first aid training within 30 days of their date of hire for 5 of 5 staff (Staff B, C, D, E and F). This failure resulted in Staff B, C, D, E and F not having the necessary training related to their job duties and placed all 31 residents at risk for compromised care and safety. Findings included .. Review of Washington Administrative Code (WAC) 388-112A-0720(2)(a) showed long-term care workers must have and maintain a valid cardiopulmonary resuscitation (CPR) and First Aid card or certificate within 30 days of their date of hire. Review of ALF's employee files showed the following: Staff 8, Care Partner. was hired on 02/19/2025. Staff B's file showed no record of completed First Aid training This document was prepared by Residential Care Services for the Locator website. 9/13/2025 8/6/2025 This document was prepared by Residential Care Services for the Locator website. 9/13/2025 8/6/2025 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2204 Compliance Determination # 63220 Plan of Correction LIGHTHOUSE MEMORY CARE Completion Date Page 5 of6 Licensee: LIGHTHOUSE MEMORY CARE LLC 07/30/2025 (2) The degree of hazardousness or toxicity posed by the supplies or equipment; This requirement was not met as evidenced by: Based on observation and interview, the Assisted Living Facility (ALF) failed to ensure potentially harmful items were safely stored away from 31 of 31 residents in the secure memory care unit. This failure resulted in high-risk items being accessible to all memory care residents and placed these residents at risk of harm from exposure to hazardous materials. Findings included ... Review of the Resident Characteristic Roster, dated 07/28/2025, showed 25 residents had a diagnosis of . On 7/28/2025 at 11 :32 AM, several counter-height storage cabinets with locking mechanisms were observed to be unlocked in the main living room. Inside the unlocked cabinets, the following items were accessible: Three bottles of "Paint and Primer" spray paint. The label on the back of the bottles read "Vapor harmful. May affect the brain or nervous system causing dizziness, headache, or nausea. Causes eye, skin, nose, and throat irritation. Intentional misuse by deliberately concentrating and inhaling the content may be harmful or fatal. Vapors may ignite explosively. Use only with adequate ventilation. Do not breathe dust, vapors, or spray mist. Ensure fresh air entry during application and drying." One bottle of "Glitter Dust" spray paint. The label on the back of the bottle read "Vapor harmful. Use with adequate ventilation. Avoid continuous breathing of vapor and spray mist. To avoid breathing vapors or spray mist, open windows and door or use other means to ensure fresh air entry during application and drying. Contains solvents that can cause permanent brain and nervous system damage. Intentional misuse by deliberately concentrating and inhaling the contents can be harmful or fatal." One bottle of "Chalkboard" and two bottles of "Fast Dry Premium Enamel" spray paint. The label on the back of the bottles read "Vapor harmful. Contains solvents which may affect the brain or nervous system causing dizziness, headache, or nausea. Intentional misuse by deliberately concentrating and inhaling the content may be harmful or fatal. Avoid contact with eyes, skin, and clothing. Use with adequate ventilation. Avoid breathing vapors or spray mist. In case of eye contact, flush thoroughly with large amounts of water for 15 minutes and get medical attention. If swallowed, do not induce vomiting. Seek medical attention immediately." This document was prepared by Residential Care Services for the Locator website. 9/3/2025 8/6/2025 This document was prepared by Residential Care Services for the Locator website.

This document was prepared by Residential Care Services for the Locator website.