Rosario Assisted Living.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98032 Statement of Deficiencies License #: 2528 Compliance Determination # 57392 Plan of Correction Rosario Assisted Living Completion Date 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 an unannounced on-site complaint investigation on 04/03/2025 and 04/09/2025 of: Rosario Assisted Living 1105 27th St Anacortes, WA 98221 This document references the following complaint number(s): 173793 The following sample was selected for review during the unannounced on-site visit: 5 of 66 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Teresa Pederson-Tuley, Nursing Consultant Institutional Jodi Condyles, ALF Licensor From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 . Statement of Deficiencies License #: 2528 Compliance Determination # 57392 Plan of Correction Rosario Assisted Living Completion Date 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 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. Administrator (or Representative) Date WAC 388-78A-2100 Ongoing assessments. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure a complete and accurate assessment was completed for 1 of 5 residents (Resident 1) with skin wounds. This failure resulted in Resident 1 being hospitalized due to sepsis and untreated wounds. Findings included… Resident 1 was admitted to the ALF on /2025 with multiple diagnoses including and . Record review of the ALF’s “Accepting and Retaining Residents” policy dated 12/19/2024, showed that the Community’s ability to meet the resident needs shall be based upon a comprehensive pre- admission evaluation of the resident’s physical, health and social needs including preferences and potential risks. In subsection “Admissions”, the facility will schedule an in home and in person evaluation no more than 15 days and at least 5 days prior to a prospective move in date, unless circumstanced justify an “emergency” move in as defined in Washington State Administrative Code (WAC) 288-78A-2070. Record review of the ALF’s “Skin Care Management” Policy dated 12/19/2024, subsection titled “Skin Assessment”, showed that a licensed nurse will perform a head-to-toe assessment upon admission. The resident will be routinely observed during . Statement of Deficiencies License #: 2528 Compliance Determination # 57392 Plan of Correction Rosario Assisted Living Completion Date showers, toileting and dressing by a caregiver ongoing. Any redness or open areas, new bruising or tears will be reported to the Shift Supervisor or Wellness Director. Record review of the ALF’s “Pre-Admission Assessment Worksheet” completed by the Staff C (Director of Clinical Services) on 02/26/2025, showed no visual skin assessment was completed or history of skin related issues documented. Record review of Resident 1’s “Person Centered Assessment and Service Plan” dated /2025, showed Resident 1 required care staff assistance with toileting including peri-care and use of incontinent products. Resident 1 was to receive standby assistance with showers twice a week. Stand by assistance included washing the skin surfaces Resident 1 could not reach and ensured the residents’ skin folds were completely dry. The only wound identified was on the bottom of the left foot. Record review of Resident 1’s progress notes dated 03/05/2025, showed Resident 1 visited their physician on 03/04/2025 who ordered Triad Ointment for skin lesions of the sacrum and groin. Resident 1 was placed on alert charting from 03/05/2025 through 03/09/2025 for on-going redness and irritation of the groin. On 03/09/2025 Resident 1 continued to have vaginal redness with symptoms of a yeast infection. From 03/09/2025 through Resident 1’s admission to Island Hospital on /2025, there was no documentation of the vaginal redness, signs of a yeast infection or notification of change in Resident 1’s condition to the primary care physician. On 04/09/2025 at 2:30 PM, Staff A (Executive Director) stated that the pre-admission assessment was completed at Island Hospital. Other than bruising at the IV sites, there were no concerns noted on Resident 1’s skin. The assessment was completed with the discharge orders from the hospital, the resident and the residents’ Power of Attorney (POA). On 04/09/2025 at 2:39 PM, Staff B (Wellness Director) stated that on 02/26/2025 the ALF didn’t have a facility nurse to complete the assessment. They contacted Staff C to complete the assessment while Resident 1 remained at Island hospital. Staff B stated the assessment used wasn’t the regular document as assessments were routinely completed in electronic records. Staff B stated that they didn’t realize that Resident 1 had reddened areas on their abdominal folds, vaginal redness or hemorrhoids. On 04/09/2025 at 3:00 PM, Staff E (Nursing Assistant) stated that on 03/29/2025 during the PM shift, they assisted with taking Resident 1 into the bathing room, collected bathing supplies, turned on the water, then sat in a chair waiting for Resident 1 to ask for assistance with showering. Staff E stated that they saw small amounts of blood on the washcloth after Resident 1 had washed their peri area. Staff E stated that they had not looked at Resident 1’s back and were not aware of any additional wounds. Staff E . Statement of Deficiencies License #: 2528 Compliance Determination # 57392 Plan of Correction Rosario Assisted Living Completion Date stated that they told the Medication Technician about the blood on the washcloth, but didn’t document on the shower sheet. On 04/09/2025 at 7:10 PM, Collateral Contact (CC1) stated that the ALF had a nurse from outside the area and the marketing person complete the pre-admission assessment at the hospital. CC1 stated that the nurse said she was not familiar with the assessment document she was filling out and asked the marketing person for assistance with completing it. CC1 stated that the nurse did not ask about chronic issues. CC1 stated that they were never told about any skin issues or a wound and only discovered them when Resident 1 was admitted to the hospital on /2025. On 04/15/2025 at 11:23 AM, Staff D (Community Relations Director) stated that they accompanied Staff C to Island Hospital Emergency Department to complete a pre-admission assessment. Staff D stated that the son and daughter were present in the room and a visual skin assessment was completed of Resident 1’s legs but not of any other skin surfaces. On 04/15/2025 at 12:59 PM, Staff B stated that an updated assessment and negotiated service plan had not been completed by the ALF. On 04/15/2025 at 1:20 PM, Staff C stated that they were the regional nurse, and the pre-assessment was something they normally completed. Staff C stated that they went ahead and completed the assessment, taking notes as the son, daughter, and resident provided additional information. Staff C stated that the resident was larger in size and a visual skin assessment. Staff C stated that they believe the full skin assessment was completed once the resident admitted to the ALF. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, Rosario Assisted Living is or will be in compliance with this law and / or regulation on (Date)________________ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date .

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98032 Statement of Deficiencies License #: 2528 Compliance Determination # 56104 Plan of Correction Rosario Assisted Living Completion Date 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 an unannounced on-site complaint investigation on 03/12/2025 of: Rosario Assisted Living 1105 27th St Anacortes, WA 98221 This document references the following complaint number(s): 169128, 169365, 169374 The following sample was selected for review during the unannounced on-site visit: 5 of 66 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Helen Fisher, Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 . Statement of Deficiencies License #: 2528 Compliance Determination # 56104 Plan of Correction Rosario Assisted Living Completion Date 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 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. Administrator (or Representative) Date WAC 388-78A-2180 Activities. The assisted living facility must: (1) Provide space and staff support necessary for: (a) Each resident to engage in independent or self-directed activities that are appropriate to the setting, consistent with the resident's assessed interests, functional abilities, preferences, and negotiated service agreement; and (b) Group activities at least three times per week that may be planned and facilitated by caregivers consistent with the collective interests of a group of residents. This requirement was not met as evidenced by: Based on observation, interviews and record reviews, the Assisted Living Facility (ALF) failed to ensure activities were provided for 2 of 2 memory care cottages (Adam and Baker) when there were no activities provided for two months. This failure resulted in a diminished quality of life for all memory care residents. Findings included… Review of the ALF’s record title “resident characteristic roster” showed the ALF had 4 cottages. Two of the cottages were assisted living and two were memory care cottages named Adam and Baker. On 03/12/2025 at 11:10 AM, several residents were observed in Adam’s cottage common dining room. The residents were sitting in wheelchairs and/or dining room table chairs. The residents were observed staring around the room. No activities were occurring and no activity items were visible in the room. . Statement of Deficiencies License #: 2528 Compliance Determination # 56104 Plan of Correction Rosario Assisted Living Completion Date On 03/12/2025 at 11:15 AM, a resident was observed in Baker’s cottage watching television, in the dark television room and several residents were sitting in wheelchairs at the dining room napping. Two residents were observed pacing around the dining room. No activities were occurring and no activity items were observed in the room. Review of the activity schedule dated March 12, 2025, showed “gardening lovers’ group”. In an interview, on 03/12/2025 at 11:20 AM, Staff A, Memory Care Director, stated that the AFL had not had an activity director since 02/10/2025. Staff A stated that the caregivers were asked to do individual activities during the day. Staff A stated the ALF was looking for an activity person. In an interview on 03/12/2025 at 11:42 AM, Staff B, Caregiver, stated that there was no activity going on. Staff B stated that families were not happy because there had been no group activities for 2 months. An undated face sheet showed Resident 1 was admitted to the ALF on /2025 with multiple diagnosis including . In an interview on 03/12/2025 at 11:56 AM, Resident 1 stated that they watched television and took naps since they moved in 8 days ago. Resident 1 stated that they did not know if there was an activity going. In an interview on 03/15/2025 at 1:53 PM, Collateral contact 1(CC1) stated that Resident 1 was alert, oriented to self, and able to carry a conversation with mild cognitive impairment. An undated face sheet showed Resident 2 was admitted to the ALF on /2025 with multiple diagnosis including . In an interview on 03/12/2025 at 12:09 PM, Resident 2 stated that there was nothing going aside from “watching television and that’s about it.” Resident 2 stated that they liked music. In an interview on 04/17/2025 at 4:13 PM, Collateral contact 2 (CC) stated that Resident 2 was alert, oriented to self and had no diagnosis. In an interview on 03/12/2025 at 12:17 PM, Staff C, Caregiver, stated that they tried to do individual activities with residents when they had the time. Staff C stated that resident care was their priority. . Statement of Deficiencies License #: 2528 Compliance Determination # 56104 Plan of Correction Rosario Assisted Living Completion Date In an interview on 03/12/2025 at 12:40 PM, Staff D, Executive Director, stated, “we no longer have an Activity Director, we need to hire someone.” Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, Rosario Assisted Living is or will be in compliance with this law and / or regulation on (Date)________________ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date .

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . . . .

Citations written. 3) The ALF followed their Medication Management policy and assessed the named Resident to be able to safely administered their medication. . Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: Rosario Assisted Living Provider Type: Assisted Living Facility License/Cert.#: 2528 Compliance Determination #: 21441 Intake ID: 74305 Investigator: Judith Mellon Region/Unit #: RCS Region 2 / Unit A Investigation Date(s): 03/21/2023 through 04/21/2023 Complainant Contact Date(s): Allegation(s): 1. The Named Resident (NR) had multiple falls in the Assisted Living Facility (ALF). 2. The NR's call pendant does not work. Investigation Methods: Sample: Total residents: 50 Resident sample size: 12 Closed records sample size: Observations: Identified resident Residents Resident rooms Staff to resident interactions Call pendant response time Interviews: Identified resident Identified staff Family Record Reviews: All Alarms Report Negotiated Service Agreement Investigation Summary: 1. The Named Resident had multiple falls identified in the Assisted Living Facility. The Named Resident’s Negotiated Service Agreement was not updated to meet the named Resident’s current level of care. 2. The Named Resident's call pendant was located on the night stand and not working when activated. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 3906-172nd St NE, Suite #100, Arlington, WA 98223 AMENDED 04/21/2023 CERTIFIED MAIL 9489 0090 0027 6382 8334 09 Licensee: Soundview Rehabilitation and Health Care Inc Rosario Assisted Living 1105 27th St Anacortes, WA 98221 RE: Rosario Assisted Living License # 2528 Dear Administrator: The Department completed a full inspection and a complaint investigation of your Assisted Living Facility on 04/21/2023 and found that your facility does not meet the Assisted Living Facility licensing requirements. The Department: • Wrote the enclosed Statement of Deficiencies (SOD) report; and • May take licensing enforcement action based on any deficiency listed on the enclosed report; and • May inspect the facility to determine if you have corrected all deficiencies. You Must: • Begin the process of correcting the deficiency or deficiencies immediately; • Contact the Field Manager for clarifications related to the Statement of Deficiencies (SOD); • Within 10 calendar days after you receive this letter, complete and return the enclosed 'Plan/Attestation Statement'; o Sign and date the enclosed report; o For each deficiency, indicate the date you have or will correct each deficiency; o Next to each deficiency, sign and date certifying that you have or will correct each cited deficiency; and o Mail the Plan/Attestation Statement and report with original signatures to: . Soundview Rehabilitation and Health Care Inc Rosario Assisted Living # 2528 04/21/2023 Kimberley Ripley, Field Manager Region 2, Unit A 3906-172nd St NE, Suite #100 Arlington, WA 98223 • Complete correction(s) within 45 days, or sooner if directed by the Department, after review of your proposed correction dates. • Have your plan approved by the Department. You May: • Receive a letter of enforcement action based on any deficiency listed on the enclosed report. In Addition, You May: • Request an Informal Dispute Resolution (IDR) review within 10 working days after you receive this letter. Your IDR request must include: o What specific deficiency or deficiencies you disagree with; o Why you disagree with each deficiency; and o Whether you want an IDR to occur in-person, by telephone or as a paper review. o Send your request to: IDR Program Manager Department of Social and Health Services Olympia, WA 98504-5600 If You Have Any Questions: • Please contact me at (360)651-6846. Sincerely, Kimberley Ripley, Field Manager Region 2, Unit A Enclosure . . . . . . . . . . . . .