Prestige Senior Living Auburn Meadows.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . . Statement of Deficiencies License #: 2239 Compliance Determination # 64272 Plan of Correction Prestige Senior Living Auburn Meadows 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-2040 Other requirements. (2) The assisted living facility must have its building approved by the Washington state fire marshal in order to be licensed. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure 94 of 94 residents (Residents 1 to 94) resided in a safe environment that is approved of by the State Fire Marshal. This failure placed all 94 residents at risk of harm, injury, and potential fire hazards related to unsafe environmental conditions. Findings included… Review of document titled" Washington State Patrol Fire Protection Bureau", dated 08/07/2025, showed the facility failed a third Fire Marshal inspection. The document showed the facility was unable to provide fire alarm correction report to the fire marshal. The document showed the facility failed to meet required fire safety regulations. During an interview on 08/20/2025 at 2:00 PM, Staff A, Director of Operations, stated that they were unaware the facility was out of compliance with the State Fire Marshal regulations. Staff A stated that the facility will create a plan to get back into compliance. Staff A stated they will consult with the facility maintenance director to initiate and complete plan of correction. . . Statement of Deficiencies License #: 2239 Compliance Determination # 64272 Plan of Correction Prestige Senior Living Auburn Meadows Completion Date 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, Prestige Senior Living Auburn Meadows 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 .

Statement of Deficiencies License #: 2239 Compliance Determination # 53622 Plan of Correction Prestige Senior Living Auburn Meadows 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 the unannounced on-site full inspection on 01/28/2025 and 01/31/2025 of: Prestige Senior Living Auburn Meadows 945 22nd St NE Auburn, WA 98002 The following sample was selected for review during the unannounced on-site visit: 9 of 82 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Claudia Allis, ALF Licensor Steven Garrett, LT C Licensor Jane Hermano, NCI From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 . 02.11.2025 16:24:57 State of Washington 8/ Statement of Deficiencies License#: 2239 c·orrlPliance Determination # 53622 Plan of Correction Prestige Senior Living Auburn Meadows 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. 02/11/2025 I understand lhat to maintain an Assisted Living Facility license, tt)e facility must be in compliance with all the licensing laws and regulations at all times. WAC 388-78A-2480 Tuberculosis Testing Required. {1) The assisted living facility must develop and implement a system to ensure each staff person is screened for tuberculosis within three days of employment. This requirement was not met as evidenced by: Based on interview and record review the facility failed to ensure 3 of 6 staff (Staff B, Staff C, and Staff D) were screened for Tuberculosis {TB), as required. This failure placed all 82 residents at risk of exposure to Tuberculosis, an infectious disease. Findings included ... Review of the facility's undated personnel records showed the facility hired Staff B, Med Tech, on 08/13/2024; Staff C, Patient Care Assistant (PCA) on 04/10/2024; and Staff D, PCA, on 07/02/2024, Review of the facility's staff schedule showed that from 08/13/2024 through 01 /27i 2025, Staff B worked at the facility providing care and services for residents. Review of Staff B's personnel records showed no documentation that Staff B completed TB screening and testing within 3 days of the date of hire. Review of the facility's staff schedule showed that from 04/10/2024 through 01 /27i2025. Staff C worked at the facility providing care and services for residents. Review of Staff C's personnel records showed no documentation that Staff C completed TB screening and testing within 3 days of the date of hire. Review of the facility's staff schedule showed that from 07/02/2024 through . 02.11.2025 16:24:57 State of Washington 9/ Statement of Deficiencies License#: 2239 Compliance Determination # 53622 Plan of Correction Prestige Senior Living Auburn Meadows Completion Date Page3 of10 Licensee: CHP Auburn WA Tenant Corp 02/10/2025 01/27/2025, Staff D worked at the facility providing care and services for residents. Review of Staff D's personnel records showed no documentation that Staff D completed TB screening and testing within 3 days of the date of hire. During an interview on 01/31/2024 at 1 :15 PM, Staff A, Executive Director, stated that they were unaware Staff B, Staff C, and Staff D were not tested for TB upon hire. 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, Prestige Senior Living Auburn Meadows is or will be in compliance with this law and I or regulation on 7 (Date) 3 / Q. J So&5 In addition, I will implement a system to monitor and ensure continued compliance with ·s requirement. __ ....- .d,.)_L9.)_e.o..'q_s:_- Date WAC 388-78A-24642 Background checks National fingerprint background check. (1) Administrators and all caregivers who are hired after January 7, 2012 and are not disqualified by the Washington state name and date of birth background check, must complete a national fingerprint background check and follow department procedures. This requirement was not met as evidenced by: Based on record review and interview, the facility failed to submit a request for a national fingerprint background check for 2 of 6 staff (Staff B and Staff D) prior to having unsupervised contact with facility residents. This failure placed all 82 residents at risk of potential abuse or neglect by a caregiver with an unknown background. Findings included ... Review of the facility's staff schedule showed that from 08/13/2024 through 01/27/2025, Staff B, MedTech, worked at the facility providing care and services for residents. Review of Staff B's personnel records st,owed no documentation that Staff B completed a national fingerprint background check and followed department procedures. Review of the facility's staff schedule showed that from 07/02/2024 through 01/27/2025, Staff D, Patient Care Assistant (PCA), worked at the facility providing care and services for residents. Review of Staff D's personnel records showed no documentation that Staff D completed a national fingerprint background check and . 02.11.2025 16:24:57 State of Washington 10/ Statement of Deficiencies License#: 2239 Compliance Determination # 53622 Plan of Correction Prestige Senior Living Auburn Meadows Completion Date followed department procedures. During an interview on 01/31/2025 at 1:10 PM, Staff A, Executive Director, stated that the facility failed to submit the request for a national fingerprint background check for Staff B and Staff D when both were hired. 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, Prestige Senior Living Auburn Meadows is or will be in compliance with this law and / or regulation on (Date) 3 / [}. 1 I aoa 5--: I I In addition, I will implement a system to monitor and ensure continued compliance with this equirernent. ···--·D--))9j q(le_~---··· Date WAC 388-78A-2100 Ongoing assessments. (2) The assisted living facility must (a) Complete a full assessment addressing the elements set forth in WAC 388-?SA-2090 for each resident at least annually; (b) Complete an assessment specifically focused on a resiclent's identified problems and related issues: (i) Consistent with the resident's change of condition as specified in WAC 388-78A-2120; (ii) \Nhen the resident's negotiated service agreement no longer addresses the resident's current needs and preferences; (iii) When the resident has an injury requiring the intervention of a practitioner. This requirement was not met as evidenced by: Based on observation, interview. and record review, the facility failed to complete 3 of 9 sampled residents (Resident 1, Resident 4, and Resident 5) assessments that included the required full assessment components. This failure placed Resident 1, Resident 4, and Resident 5 at risk of harm from unidentified care needs and changes in condition. Findings included ... RESIDENT 1 . Statement of Deficiencies License #: 2239 Compliance Determination # 53622 Plan of Correction Prestige Senior Living Auburn Meadows Completion Date Review of Resident 1's records showed the facility admitted Resident 1 on /2007. The records showed Resident 1 admitted with diagnoses of: . Review of Resident 1's assessment, dated 05/29/2024, showed no documentation of Resident 1's current prescribed medications. The assessment showed no documentation of Resident 1's diagnosed . There was no documentation of Resident 1' s delusional ideations, and no guidance for staff to follow if Resident 1 experienced any delusions, no guidance to notify nursing staff, and no directions related to documenting Resident 1' s delusional incidents. There was no documentation of Resident 1' s history of medication over-dose and medication "pocketing" (hiding of medications in the cheek). There were no instructions for staff to follow to ensure Resident 1 swallowed crushed medications at time of administration RESIDENT 4 Review of Resident 4's records showed the facility admitted Resident 4 on /2022. The records showed Resident 4 admitted with diagnoses of: , and . Review of Resident 4's assessment, dated 11/12/2024, showed no documentation of Resident 4's seizure disorder, with information about the type of seizures, the frequency of seizures, and medications used to manage the seizure disorder. There were no instructions for care staff to notify nursing staff and document Resident 4's seizures. There was no documentation of Resident 4's current prescribed seizure medication, Keppra, 500 milligrams, tablet given twice daily by mouth, and any potential side effects of the medications. There was no documentation of Resident 4's other prescribed medications and any potential side effects of the medications .

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