Sunrise of Redmond.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Aging and Long-Term Support Administration PO Box 45600, Olympia, WA 98504-5600 May 30, 2025 ELECTRONIC-FACSIMILE Administrator Sunrise of Redmond 15241 NE 20TH ST BELLEVUE, WA 98007 Assisted Living Facility License # 2464 Licensee: Sunrise Senior Living Management Inc IMPOSITION OF CIVIL FINE Dear Administrator: On May 20, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a follow-up visit at your facility. This letter constitutes formal notice of a civil fine on the license for your assisted living facility, also known as Sunrise of Redmond, located at 15241 NE 20TH ST, BELLEVUE, by the State of Washington, Department of Social and Health Services. These actions are taken under the authority granted pursuant to Laws of 1998, Chapter 272 and RCW 18.20.190. The civil fine on the license is based on the following violation of the RCW and/or WAC as described in the attached Statement of Deficiencies (SOD) report dated May 20, 2025. Civil Fine WAC 388-78A-2040 (2) Other requirements. $600.00 The licensee failed to ensure 98 residents resided in a safe environment that is in compliance with the State Fire Marshal regulations. This failure placed all residents at risk of harm, injury, and potential fire hazards related to unsafe environmental conditions. This is an uncorrected deficiency previously cited on February 7, 2025. NOTE: This is the violation, which resulted in the fine; see the attached Statement of Deficiencies for any additional violations. Administrator Sunrise of Redmond License # 2464 May 30, 2025 Page 2 Attestation (Plan of Correction): Return the enclosed SOD within 10 calendar days with the following: • The date you have or will have each deficiency corrected; • A signature and date attesting that you are taking actions to correct and maintain correction for each cited deficiency. Return the signed and dated SOD to: Laurie Anderson, Field Manager Region 2, Unit D 20425 72nd Ave S suite 400 Kent, WA 98032-2388 Phone: (253)234-6020 / Fax: (253) 395-5071 rcsregion2email@dshs.wa.gov Appeal Rights: You have two appeal rights: Informal Dispute Resolution (IDR) and an Administrative Hearing. Each has a different request timeline. Informal Dispute Resolution [RCW 18.20.195] You have an opportunity to challenge the deficiencies and/or enforcement actions through the state's IDR process. All IDR requests must be in writing and include: • The deficiencies you are disputing; and • The method of review you prefer (face-to-face, telephone conference or documentation review). The written request must be received by the 10th working day from receipt of this letter. During the IDR process, you will have the opportunity to present written and/or oral evidence to dispute the deficiencies. Please email your request(s) and supporting documentation to: RCSIDR@dshs.wa.gov OR FAX to: 360-725-3225 Administrator Sunrise of Redmond License # 2464 May 30, 2025 Page 3 Formal Administrative Hearing You may contest the civil fine by requesting a formal administrative hearing to challenge the deficiency, which resulted in the civil fine. All hearing requests must be in writing and include: • A copy of this letter; and • A copy of the Statement of Deficiencies. The written request must be received within twenty-eight (28) calendar days of receipt of this letter. Send your written request to: Office of Administrative Hearings PO Box 42489 Olympia, Washington 98504-2489 Payment: If you do not request a formal administrative hearing, the civil fine is due to the Office of Financial Recovery twenty-eight (28) calendar days after receipt of this letter. Mail a check for $600.00 payable to the ‘Department of Social and Health Services’, and if you have or have had a Medicaid resident(s), please include your ProviderOne ID Number # on the check, to: DSHS Office of Financial Recovery PO Box 9501 Olympia, WA 98507-9501 (360) 664-5919 / FAX: (360) 664-8401 OFRMMISVendor@dshs.wa.gov If the Office of Financial Recovery has not received your payment within twenty-eight (28) days after receipt of this letter, interest will begin to accrue immediately on the balance, at the rate of one percent per month. If you do not submit a hearing request or make payment within twenty-eight (28) days, the balance due will be recovered. Administrator Sunrise of Redmond License # 2464 May 30, 2025 Page 4 NOTICE: State and federal law provide protections to defendants who are in military service, and to their dependents. Dependents of a service member are the service member’s spouse, the service member’s minor child, or and individual for whom the service member provided more than one-half of the individual’s support for one hundred eight days immediately preceding an application for relief. One protection provided is the protection against the entry of a default judgment in certain circumstances. This notice pertains only to a defendant who is a dependent of a member of the National Guard or a military reserve component under a call to active service, or a National Guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days. Other defendants in military service also have protections against default judgments not covered by this notice. If you are the dependent of a member of the national guard or a military reserve component under a call to active service, or a national guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days, you should notify the Department in writing of your status as such within twenty days of the receipt of this notice. If you fail to do so, then a court or an administrative tribunal may presume that you are not a dependent of an active duty member of the national guard or reserves, or a national guard member under a call to service authorized by the governor of the state of Washington, and proceed with the entry of an order of default and/or a default judgment without further proof of your status. Your response to the Department about your status does not constitute an appearance for jurisdictional purposes in any pending litigation nor a waiver of your rights. If you have any questions, please contact Laurie Anderson, Field Manager, at (253) 234-6020. Sincerely, Rathana Duong Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 2, Unit D RCS Regional Administrator, Region 2 HCS Regional Administrator, Region 2 DDA Regional Administrator, Region 2 WA LTC Ombuds Office of Financial Recovery, Vendor Program Unit HQ Central Files DRW HP

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration PO Box 45600, Olympia, WA 98504-5600 September 3, 2025 ELECTRONIC-FACSIMILE Administrator Sunrise of Redmond 15241 NE 20TH ST BELLEVUE, WA 98007 Assisted Living Facility License # 2464 Licensee: Sunrise Senior Living Management Inc IMPOSITION OF CIVIL FINE Dear Administrator: On August 20, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a follow-up visit at your facility. This letter constitutes formal notice of a civil fine on the license for your assisted living facility, also known as Sunrise of Redmond, located at 15241 NE 20TH ST, BELLEVUE, by the State of Washington, Department of Social and Health Services. These actions are taken under the authority granted pursuant to Laws of 1998, Chapter 272 and RCW 18.20.190. The civil fine on the license is based on the following violation of the RCW and/or WAC as described in the attached Statement of Deficiencies (SOD) report dated August 20, 2025. Civil Fine WAC 388-78A-2040 (2) Other requirements. $900.00 The licensee failed to ensure 104 residents resided in a safe environment that was approved of by the state fire marshal. This failure placed all residents at risk of harm, injury, and potential fire hazards related to unsafe environmental conditions. This is an uncorrected deficiency previously cited on May 20, 2025, for subsection (2) and a recurring deficiency previously cited on February 7, 2025, for subsection (2). NOTE: This is the violation, which resulted in the fine; see the attached Statement of Deficiencies for any additional violations. Administrator Sunrise of Redmond License # 2464 September 3, 2025 Page 2 Attestation (Plan of Correction): Return the enclosed SOD within 10 calendar days with the following: • The date you have or will have each deficiency corrected; • A signature and date attesting that you are taking actions to correct and maintain correction for each cited deficiency. Return the signed and dated SOD to: Laurie Anderson, Field Manager Region 2, Unit D 20425 72nd Ave S suite 400 Kent, WA 98032-2388 Phone: (253)234-6020 / Fax: (253) 395-5071 rcsregion2email@dshs.wa.gov Appeal Rights: You have two appeal rights: Informal Dispute Resolution (IDR) and an Administrative Hearing. Each has a different request timeline. Informal Dispute Resolution [RCW 18.20.195] You have an opportunity to challenge the deficiencies and/or enforcement actions through the state's IDR process. All IDR requests must be in writing and include: • The deficiencies you are disputing; and • The method of review you prefer (face-to-face, telephone conference or documentation review). The written request must be received by the 10th working day from receipt of this letter. During the IDR process, you will have the opportunity to present written and/or oral evidence to dispute the deficiencies. Please email your request(s) and supporting documentation to: RCSIDR@dshs.wa.gov OR FAX to: 360-725-3225 Administrator Sunrise of Redmond License # 2464 September 3, 2025 Page 3 Formal Administrative Hearing You may contest the civil fine by requesting a formal administrative hearing to challenge the deficiency, which resulted in the civil fine. All hearing requests must be in writing and include: • A copy of this letter; and • A copy of the Statement of Deficiencies. The written request must be received within twenty-eight (28) calendar days of receipt of this letter. Send your written request to: Office of Administrative Hearings PO Box 42489 Olympia, Washington 98504-2489 Payment: If you do not request a formal administrative hearing, the civil fine is due to the Office of Financial Recovery twenty-eight (28) calendar days after receipt of this letter. Mail a check for $900.00 payable to the ‘Department of Social and Health Services’, and if you have or have had a Medicaid resident(s), please include your ProviderOne ID Number # on the check, to: DSHS Office of Financial Recovery PO Box 9501 Olympia, WA 98507-9501 (360) 664-5919 / FAX: (360) 664-8401 OFRMMISVendor@dshs.wa.gov If the Office of Financial Recovery has not received your payment within twenty-eight (28) days after receipt of this letter, interest will begin to accrue immediately on the balance, at the rate of one percent per month. If you do not submit a hearing request or make payment within twenty-eight (28) days, the balance due will be recovered. Administrator Sunrise of Redmond License # 2464 September 3, 2025 Page 4 NOTICE: State and federal law provide protections to defendants who are in military service, and to their dependents. Dependents of a service member are the service member’s spouse, the service member’s minor child, or and individual for whom the service member provided more than one-half of the individual’s support for one hundred eight days immediately preceding an application for relief. One protection provided is the protection against the entry of a default judgment in certain circumstances. This notice pertains only to a defendant who is a dependent of a member of the National Guard or a military reserve component under a call to active service, or a National Guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days. Other defendants in military service also have protections against default judgments not covered by this notice. If you are the dependent of a member of the national guard or a military reserve component under a call to active service, or a national guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days, you should notify the Department in writing of your status as such within twenty days of the receipt of this notice. If you fail to do so, then a court or an administrative tribunal may presume that you are not a dependent of an active duty member of the national guard or reserves, or a national guard member under a call to service authorized by the governor of the state of Washington, and proceed with the entry of an order of default and/or a default judgment without further proof of your status. Your response to the Department about your status does not constitute an appearance for jurisdictional purposes in any pending litigation nor a waiver of your rights. If you have any questions, please contact Laurie Anderson, Field Manager, at (253) 234-6020. Sincerely, Matt Hauser Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 2, Unit D RCS Regional Administrator, Region 2 HCS Regional Administrator, Region 2 DDA Regional Administrator, Region 2 WA LTC Ombuds Office of Financial Recovery, Vendor Program Unit HQ Central Files DRW SN

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98032 Sunrise Senior Living Management Inc Sunrise of Redmond 15241 NE 20TH ST BELLEVUE, WA 98007 RE: Sunrise of Redmond License # 2464 Dear Administrator: This letter addresses Compliance Determination(s) 32011 (Completion Date 11/02/2023) and 28958 (Completion Date 09/01/2023). The Department completed a follow-up inspection of your Assisted Living Facility on 11/02/2023 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-2320-3-a, WAC 388-78A-2320-3-b, WAC 388-78A-2320-3-c, WAC 388-78A- 2320-3-d, WAC 388-78A-2320-3-e, WAC 388-78A-2320-3 The Department staff who did the on-site verification: Thomas Forkgen, ALF Licensor If you have any questions, please contact me at (253)234-6020. Sincerely, Laurie Anderson, Field Manager Region 2, Unit D Residential Care Services This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Sunrise of Redmond Provider Type: Assisted Living Facility License/Cert.#: 2464 Compliance Determination #: 28958 Intake ID: 96375 Investigator: Thomas Forkgen Region/Unit #: RCS Region 2 / Unit D Investigation Date(s): 08/30/2023 through 09/01/2023 Complainant Contact Date(s): Allegation(s): Nurse delegation not done correctly for staff delegated to administer insulin. Investigation Methods: Sample: Total residents: 67 Resident sample size: 1 Closed records sample size: 0 Observations: Observed staff interacting with residents. Observed staff dispensing medications Interviews: Interviewed sampled resident who is a insulin dependent diabetic. Interviewed the Executive Director (administrator of record) and Health Services Director, Registered Nurse Delegator (RND). Record Reviews: Reviewed nurse delegation paper work. Investigation Summary: Facility RND did not do the follow-up visits required after a staff member received initial delegation for insulin administration. There were no records to show the visits occurred weekly, for four weeks after initial delegation. During an interview the RND confirmed there were no documents for the follow-up visits and they were unaware of the requirement. RND also admitted they did not observed the initial delegation administration of insulin. RND did not realize it was required. Facility was citied for failed practice. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. 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 #: 2464 Compliance Determination # 28958 Plan of Correction Sunrise of Redmond Completion Date Page 1 of 3 Licensee: Sunrise Senior Living Management Inc 09/01/2023 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 08/30/2023 and 08/30/2023 of: Sunrise of Redmond 15241 NE 20TH ST BELLEVUE, WA 98007 This document references the following complaint number(s): 96375 The following sample was selected for review during the unannounced on-site visit: 1 of 67 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Thomas Forkgen, ALF Licensor From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit D 20425 72nd Avenue S, Suite 400 Kent, WA 98032 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. 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. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 28958 Plan of Correction Sunrise of Redmond Completion Date Page 2 of 3 Licensee: Sunrise Senior Living Management Inc 09/01/2023 Administrator (or Representative) Date WAC 388-78A-2320 Intermittent nursing services systems. (3) The assisted living facility must ensure that all nursing services, including nursing supervision, assessments, and delegation, are provided in accordance with applicable statutes and rules, including, but not limited to: (a) Chapter 18.79 RCW, Nursing care; (b) Chapter 18.88A RCW, Nursing assistants; (c) Chapter 246-840 WAC, Practical and registered nursing; (d) Chapter 246-841 WAC, Nursing assistants; and (e) Chapter 246-888 WAC, Medication assistance. This requirement was not met as evidenced by: Based on interview and record review the facility failed to ensure that 1 of 1 resident (Resident 6) received proper nurse delegation services from staff that completed full diabetic nurse delegation training. This failure placed Resident 6 at risk of improper insulin administration and potential for compromised health. Findings included… Review of the facility's Nurse Delegation binder showed a Department of Social and Health Services (DSHS) delegation form titled "Nurse Delegation: Nursing Visit", dated 07/24/2023, for Resident 6. Review of the forms showed that on 07/24/2023, seven staff were delegated to administer insulin for Resident 6. Review of Washington Administrative Code (WAC) 388-78A-2020 "Definitions" showed "'Document' means to record, with signature, title, date, and time: information about medication administration, medication assistance or nursing care procedure, and processes that are required by law, rule, or policy". Review of the facility's undated document titled "Assisted Living Resident Characteristics Roster" showed that the facility admitted Resident 6 in 2023. The document showed Resident 6 was an insulin dependent diabetic. Review of the facility's Nurse Delegation binder contained DSHS delegation forms "Nurse Delegation: Nursing Visit" forms for Resident 6. The forms were used to document the nurse delegation for insulin administration. Review of form dated 07/24/2023 showed no documentation or other forms of verification by the facility's RND, Staff B, Registered Nurse, Resident Care Director, that the seven staff delegated to administer insulin to Resident 6 were observed or supervised when insulin was administered. There was no This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 28958 Plan of Correction Sunrise of Redmond Completion Date Page 3 of 3 Licensee: Sunrise Senior Living Management Inc 09/01/2023 documentation that Staff B completed weekly performance evaluations of the seven staff for the first four weeks after the initial delegation, as required. Review of Resident 6's August 2023 electronic Medication Administration Record (eMAR) showed an order for sliding scale insulin (Lispro- type of insulin) three times a day before meals. The eMAR showed that Staff W, Medication Manager (unlicensed staff who dispense and administer medications), administered the 4:30 PM insulin on four different Saturdays. Further review showed that on 08/17/2023, Staff X, Medication Manager, administered Resident 6's 4:30 PM insulin. During an interview on 08/30/2023 at 2:45 PM, Staff B stated that most of the Medication Technicians (Med Tech) were trained and delegated during an in-service on 07/24/2023. Staff B stated that Staff W was trained at another facility. Staff B stated that they did not observe Staff W for Resident 6's initial insulin administration delegation visit. Staff B stated that another nurse performed the observation. Staff B was unsure if there was any documentation that showed another nurse observed and supervised Staff W for insulin administration with any resident. Staff B stated that Staff W was the only Med Tech who administered insulin to Resident 6. Staff B also stated that they were unaware of requirement for four weeks of weekly supervision for newly insulin delegated staff. Staff B was unaware the supervision needed to be with each resident who received insulin delegation services. During an interview on 08/30/2023 at 3:34 PM, Staff B stated that on 07/24/2023 they completed a training with the Medication Managers. Staff B stated that the training included observation of each Medication Manager performing a return demonstration. Staff B acknowledged that the return demonstration was not done with a resident or the resident who received the nurse delegation service. Staff A, Executive Director, and Staff B stated that they reviewed the 388-78A WACs. Staff A and Staff B stated that they did not find any language or regulation that stipulated four visits were required for the delegation of insulin and that direct observation by the RND was required. Staff A stated that they also consulted with the Washington Health Care Association and reviewed the DSHS website for information on nurse delegation. Staff A stated that these consultations provided no clear information about the required four weekly visits and observation of return demonstrations. Staff A and Staff B both stated they were unaware of WAC 246-840-930 regulations tied in with the 388-78A-2320 WAC. 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, Sunrise of Redmond 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 This document was prepared by Residential Care Services for the Locator website.

Sunrise of Redmond # 2464 09/01/2023 Page 2 of 2 Residential Care Services This document was prepared by Residential Care Services for the Locator website. 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 #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 1 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 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 05/22/2023, 05/22/2023, 05/25/2023, 05/26/2023 and 05/25/2023 of: Sunrise of Redmond 15241 NE 20TH ST BELLEVUE, WA 98007 The following sample was selected for review during the unannounced on-site visit: 7 of 59 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Thomas Forkgen, ALF Licensor Jane Hermano, NCI Michelle Yip, ALF Licensor From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit D 20425 72nd Avenue S, Suite 400 Kent, WA 98032 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. 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. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 2 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Administrator (or Representative) Date WAC 388-78A-2140 Negotiated service agreement contents. The assisted living facility must develop, and document in the resident's record, the agreed upon plan to address and support each resident's assessed capabilities, needs and preferences, including the following: (1) The care and services necessary to meet the resident's needs, including: (a) The plan to monitor the resident and address interventions for current risks to the resident's health and safety that were identified in one or more of the following: (ii) The resident's full assessments; (2) Clearly defined respective roles and responsibilities of the resident, the assisted living facility staff, and resident's family or other significant persons in meeting the resident's needs and preferences. Except as specified in WAC 388-78A-2290 and 388-78A-2340 (5), if a person other than a caregiver is to be responsible for providing care or services to the resident in the assisted living facility, the assisted living facility must specify in the negotiated service agreement an alternate plan for providing care or service to the resident in the event the necessary services are not provided. The assisted living facility may develop an alternate plan: (a) Exclusively for the individual resident; or (b) Based on standard policies and procedures in the assisted living facility provided that they are consistent with the reasonable accommodation requirements of state and federal law. (3) The times services will be delivered, including frequency and approximate time of day, as appropriate; This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to document in the resident records the potential medication side effects and caregiver instructions related to routine blood thinner therapy for 4 of 4 sampled residents (Resident 1, Resident 4, Resident 6, and Resident 7). The facility also failed to document in the resident records the various responsibilities of medication assistance and catheter care for 1 of 1 (Resident 5). These failures placed the residents at risk for unmet care needs and worsening of medical conditions. Findings included… MONITORING MEDICATION SIDE EFFECTS Review of the MedlinePlus website titled "Blood Thinners", (https://medlineplus.gov/bloodthinners.html), dated 05/31/2023, showed blood thinners (medicines that This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 3 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 prevent blood clots from forming) included aspirin. The website showed the common side effects of blood thinners included bleeding, red or brown urine, red or black bowel movements, bleeding from the gums and nose that does not stop quickly, brown or bright red vomit, coughing up something red, severe headache or stomachache, unusual bruising, a cut that does not stop bleeding, and a serious fall or bump on the head. RESIDENT 1 Review of Resident 1's "Individual Service Plan" (ISP), dated 03/25/2023, showed the facility admitted Resident 1 in 2023. The ISP showed a diagnosis of . Further review of the ISP showed no documentation of instructions to the staff about the potential side effects from taking aspirin once a day. Review of Resident 1's March 2023 and April 2023 electronic Medication Administration Records (eMAR) showed Resident 1 received 81 milligrams (mg) enteric coated (a coating on the outside of a pill that it does not dissolve in stomach acid) aspirin, one tablet by mouth, once a day, for cardiovascular health. The eMARs showed no instructions about the potential side effects staff should be aware for Resident 1, who received routine aspirin therapy. RESIDENT 4 Review of Resident 4's ISP, dated 02/28/2023, showed the facility admitted Resident 4 in 2023. The ISP showed a diagnosis of . Further review of the ISP showed no documentation of instructions to the staff about the potential side effects from taking aspirin once a day. Review of Resident 4's April 2023 and May 2023 eMAR showed Resident 4 received 81 mg enteric coated aspirin, one tablet by mouth, once a day, related to atherosclerosis of the aorta. The eMARs showed no instructions about the potential side effects staff should be aware of for Resident 4, who received routine aspirin therapy. RESIDENT 6 Review of Resident 6's ISP, dated 02/14/2023, showed the facility admitted Resident 6 in 2023. The ISP showed a diagnosis of . The ISP showed no documentation of instructions to the staff about the potential side effects from taking aspirin once a day. Review of Resident 6's March 2023, April 2023, and May 2023 eMARs showed Resident 6 received 81 mg delayed release aspirin, one tablet by mouth, one time a day, related to hyperlipidemia (a condition in which there are high levels of fat in the blood). The eMARs showed that between 03/01/2023 and 05/22/2023, the facility administered aspirin to Resident 6. The eMARs showed no instructions about the potential side effects staff should be aware of for Resident 6, who received routine aspirin therapy. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 4 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 RESIDENT 7 Review of Resident 7's ISP, dated 12/17/2022, showed the facility admitted Resident 7 in 2022. The ISP showed a diagnosis of The ISP showed no documentation of instructions to staff about the potential side effects from taking aspirin once a day. Review of Resident 7's eMARs dated March 2023, April 2023, and May 2023, showed they received aspirin, 81 milligrams (mg), one tablet by mouth one time a day for prevent heart attack. The eMARs showed that between 03/01/2023 and 05/22/2023, Resident 7 self-administered aspirin every day. The eMARs showed no instructions about the side potential side effects staff should be aware of for Resident 7, who received routine aspirin therapy. CATHETER CARE AND FAMILY MEDICATION PLAN RESIDENT 5 Review of the facility's document titled "WA 3.0 Service Evaluation and Health Assessment (SEHA) – V4" for Resident 5, dated 01/09/2023, showed that the facility admitted Resident 5 in 2022, with a diagnosis of . The document showed that Resident 5 was unable to self-administer medications. The document showed that the facility staff provided medication assistance. The document also showed that Resident 5 required catheter care assistance. Review of Resident 5's ISP, dated 01/27/2023, showed that the facility staff or private home care aide provided Resident 5 with catheter care assistance. The ISP provided no schedule of when the facility staff provided catheter care assistance and when the private HCAs provided this service. The ISP further showed Resident 5's family assisted with Resident 5's medication management. The ISP showed no documentation of a family medication plan and emergency medication plan. The ISP showed no defined care tasks for the facility staff's assistance in catheter care and medication administration. The ISP also showed no documentation of an alternate plan in case the private HCA was unavailable and absent from duty. Review of the facility's document titled "WA Medication Service Level Evaluation – V2", dated 03/04/2023, showed that Resident 5's family and private home care aides (HCA) provided medication assistance. The document showed no documentation of a family medication plan, no documentation of the facility's role and responsibility in the care coordination, and no documentation of an alternate medication plan if family were unavailable. During an interview on 05/24/2023 at 2:35 PM, Staff A, Executive Director, stated that Resident 5's private HCAs provided care assistance for two hours in the morning and two hours in the evening, every day. Staff A stated that the facility's staff provided Resident 5 with care and services for the hours the HCAs were not present or absent from duty. During an interview on 05/24/2023 at 2:50 PM, Staff B, Resident Care Director, stated that Resident 5 required assistance with medications and catheter care. Staff B stated that Resident 5's daughter prepared the medi-set (a medication organizer device) every month. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 5 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Staff B stated that they were unaware Resident 5's ISP showed no family medication plan and no alternate plan available for times when family was unavailable. Staff B stated that Resident 5 received assistance from private HCA several hours a day in coordination with the facility staff. Staff B stated that they were unaware the ISP showed no documentation of the care tasks and the facility's staff responsibilities. Staff B further stated that they were unaware Resident 5's ISP was not updated. Observation on 05/25/2023 at 8:30 AM showed that Collateral Contact 1 (CC1), Private Home Care Aide, assisted Resident 5 with personal care tasks, which included catheter care. Observation showed CC1 cleaned the urinary catheter tubing, connected the urine bag, and secured the urine bag to Resident 5's left thigh. 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, Sunrise of Redmond 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 WAC 388-78A-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services to any resident, either directly or indirectly, the assisted living facility must: (a) Develop and implement systems that support and promote the safe practice of nursing for each resident; and (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to assess and implement nurse delegation services for 3 of 3 residents (Resident 2, Resident 4, and Resident 8). These failures placed the residents at risk for medication errors and potential decline in their health when unqualified staff provided care. Findings included... Review of the facility's undated document titled "Disclosure of Services Required by RCW 18.20.300", showed the facility provided intermittent nursing services /administration by trained unlicensed staff through nurse delegation. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 6 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Review of the facility's policy titled "Nurse Delegation", dated April 2012, showed that the nurse delegator would "assess the resident's nursing care needs and determine that their condition is stable and predictable". The policy also showed that the nurse delegator would determine whether the resident could be taught to perform the task of medication administration independently or with assistance. During the entrance conference on 05/22/2023 at 9:10 AM, Staff B, Registered Nurse, Resident Care Director, identified themselves as the facility's Registered Nurse Delegator (RND). Staff B stated there were currently no residents in the facility who received or required nurse delegation services. Review of the facility's undated document titled "Assisted Living Facility Resident Characteristic Roster" showed the facility admitted Resident 2 and Resident 4 in 2023, and Resident 8 in January 2023. The roster showed that all three residents resided in the secured Memory Care unit. The roster showed Resident 2 and Resident 4 required maximum assistance with their care needs and activities of daily living. The roster showed that Resident 8 required moderate assistance with care and activities of daily living. Further review of the roster showed Resident 2 received Hospice Services (end of life care). RESIDENT 2 Review of Resident 2's Individual Service Plan (ISP), dated 03/20/2023, showed a diagnosis of Further review showed Resident 2 was "unable to self-administer" their medications and required the Medication Technicians to "assist" and "administer" the medications. Observation on 05/22/2023 at 12:28 PM, showed Resident 2 sat in a reclining wheelchair at the dining room table. Observation showed Resident 2 made no attempt to feed themselves and was unable to engage in a conversation. Further observation showed Staff L, Care Manger, fed Resident 2. Observation on 05/23/2023 at 12:05 PM, showed Staff L cut Resident 2's food into smaller bites. Then Staff L fed Resident 2 their lunch. Observation on 05/24/2023 at 7:37 AM, showed Staff K, Medication Care Manager (unlicensed staff who dispense and administer medications), crushed Resident 2's medications and mixed the crushed medications in applesauce. Staff K then spoon fed the applesauce with the medications to Resident 2. Further observation showed Staff K placed chewable medications in Resident 2's mouth with a spoon. Resident 2 showed no awareness that they received their medications. During an interview on 05/22/2023 at 12:28 PM, and on 05/23/2023 at 12:05 PM, Staff L stated that Resident 2 was mostly non-verbal. Staff L stated that Resident 2 did not know the difference between various food items. Staff L stated that they moved the silverware, napkins, and other objects away from Resident 2 to prevent them from putting the items in their mouth. Staff L stated that Resident 2 was not able to express or show whether they This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 7 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 wanted wedged potatoes or bites of the hamburger. Staff L stated that the care managers decided for Resident 2 what the next bite of food would be. During an interview on 05/24/2023 at 2:53 PM, Staff B stated that Resident 2's medical diagnoses included . Staff B acknowledged that based on the observations, Resident 2 should be on nurse delegation services. RESIDENT 4 Review of Resident 4's ISP, dated 02/28/2023, showed a diagnosis of and . Further review of the ISP showed Resident 4 had limited ability to "express" themselves and "communicate" their needs. The ISP showed Resident 4 was "unable to self- administer" medications and required the facility staff to "assist" and "administer" their medications. Observation on 05/22/2023 at 12:55 PM, showed Resident 4 sat in a recliner with only a bath towel wrapped around their waist. Resident 4 was unable to appropriately respond to questions or engage in conversation. Resident 4 verbalized several nonsensical (having no meaning, making no sense) sounds. Observation on 05/24/2023 at 8:00 AM, showed Staff L fed Resident 4 lunch. Resident 4 responded to cues to open their mouth while their eyes remained closed. Resident 4 did not attempt to feed themselves. During an interview on 05/24/2023 at 8:59 AM, Staff K stated that when they administered Resident 4's medications, they crushed them in applesauce and spoon fed the applesauce with the medications to Resident 4. Staff K stated that Resident 4 was unable to self-direct the staff to put the medications in their mouth. Staff K stated that Resident 4 would open their mouth when staff told them the medications were ready to be taken. Staff K stated that the day before, Resident 4 attempted to put the medications in their mouth and was unable to do so. Staff K stated that Resident 4 required the Medication Technicians to administer the medications for them. RESIDENT 8 Review of Resident 8's ISP dated 04/24/2023 showed a diagnosis of and . The ISP showed that Resident 8 was unable to self-administer their own medications. The ISP showed that staff assisted or administered Resident 8's medications. Observation on 05/24/2023 at 8:12 AM, showed Staff K placed Resident 8's pills in a medicine cup filled with applesauce. Staff K used a spoon to put the pills in Resident 8's mouth. Resident 8 did not ask, or direct Staff K to administer the medication. During an interview at this same time, Staff K stated that even though Resident 8 was physically This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 8 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 capable of placing the pills in their own mouth, the staff did it for them. Staff K stated that when Resident 8 administered their own medications, they would take more than one pill at a time, which would cause them to choke. Staff K stated that to prevent Resident 8 from choking, it was necessary for staff to administer Resident 8's medications for them. During an interview on 05/24/2023 at 12:56 PM, Staff M, Reminiscence Coordinator, stated that they were not responsible for the nurse delegation. Staff M stated that the licensed nurses were the ones who determined which residents required nurse delegation. Staff M stated that Staff B was the person responsible to complete the nurse delegation assessments and services. During an interview on 05/24/2023 at 2:53 PM, Staff B stated that nurse delegation occurred when a resident was no longer able to put the medications in their mouth and were unable to direct the Med Techs to do it for them. Staff B acknowledged Resident 2 showed no awareness they received medications and was not cognitively capable to direct staff to place the medications in their mouth. Staff B stated that Resident 4 had advanced dementia. Staff B agreed that Resident 4 showed no awareness they received medications and were not able to self-direct staff to administer the medications. Staff B stated that Resident 4 also required nurse delegation. Staff B stated that Resident 8 needed an evaluation to determine if nurse delegation services were appropriate. Staff B stated that the Resident Care Coordinators were responsible to communicate to the nurses when a resident was no longer able to self-administer their own medications. Staff B stated that they were unaware Resident 2, Resident 4 and Resident 8 had not been evaluated for nurse delegation. 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, Sunrise of Redmond 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 WAC 388-78A-2130 Service agreement planning. The assisted living facility must: (3) Review and update each resident's negotiated service agreement consistent with WAC 388-78A- 2120 : (a) Within a reasonable time consistent with the needs of the resident following any change in the resident's physical, mental, or emotional functioning; and (b) Whenever the negotiated service agreement no longer adequately addresses the resident's current assessed needs and preferences. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page 9 of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 This requirement was not met as evidenced by: Based on observation, interview, and record review the facility failed to update the "Individual Service Plans" (ISP) for 3 of 3 residents (Resident 2, Resident 3, and Resident 4). This failure placed the three residents at risk for not having their care needs met. Review of the facility's undated document titled "Resident Characteristics Roster" showed that the facility admitted Resident 2 in of 2023, Resident 3 in 2023, and Resident 4 in 2023. The Characteristics Roster showed that Resident 2, Resident 3, and Resident 4 resided in the secured Memory Care unit. RESIDENT 2 The Characteristics Roster showed Resident 2 received Hospice Services (end of life care). Observation on 05/22/2023 at 1:03 PM, showed Staff J, Care Manager, and Staff F, Lead Care Manager, used a Mechanical Lift to transfer Resident 2 from a reclining wheelchair to a hospital bed. Observation showed Resident 2's hospital bed had an alternating pressure relief overlay mattress on top of a regular mattress. Observation showed a non-operational air pump located at the foot of the bed. The air mattress was deflated. Further observation showed Staff J lowered Resident 2's hospital bed to the lowest position, close to the floor. Staff J placed a regular twin size mattress next to Resident 2's bed Staff J then placed a mat on top of the floor mattress. Staff J then placed a second mat next to the mattress on the floor. During an interview at this same time, Staff J stated that when Resident 2 occupied the bed, the hospital bed was needed to be in the lowest position. Staff J stated the floor mattress and mats were to prevent Resident 2 from potential injury if they rolled out of the bed. Staff J stated that the second mat protected Resident 2 if they rolled off the floor mattress. Review of Resident 2' ISP dated 03/20/2023 showed Resident 2 was diagnosed with . The ISP did not show any documentation that Resident 2 used an alternating pressure relief air mattress. The ISP provided no staff instructions to check that the pump was operational, turned on and the mattress was inflated. The ISP did not show any documentation that Resident 2 required floor mats and a mattress next to the bed. There were no instructions that informed staff on the correct sequence for positioning the mattress and pads next to the bed. The ISP did not show Resident 2 used a hospital bed. There were no instructions that informed staff to place the hospital bed in the lowest position when Resident 2 occupied the bed. During an interview on 05/24/2023 at 12:56 PM, Staff M, Memory Care Reminiscence Coordinator, stated that the hospital bed, air mattress and floor mats and mattress needed to be documented in Resident 2's ISP. Staff M stated that the floor mat should be placed next to the hospital bed. Staff M stated that they were unaware a twin-size mattress was used. Staff M stated that they were unaware of the correct sequence and position staff used for the placement of the mattress or mats. Staff M confirmed the air pump was broken. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 RESIDENT 3 Observation on 05/22/2023 at 9:41 AM, showed a Continuous Positive Airway Pressure [CPAP- a device used to keep a person's airway open when sleeping, used for people with sleep apnea (a condition where a person's breathing stops and restarts multiple times during sleep which causes oxygen deprivation)] on the nightstand in Resident 3's room. Observation showed a bottle of distilled water used to fill the CPAP reservoir sat on the floor, next to the nightstand. Review of Resident 3's ISP dated 04/21/2023 showed a diagnosis of and . The ISP did not show Resident 3 used a CPAP. The ISP did not provide staff instructions on how to manage or care for the CPAP or when the CPAP was to be used. During an interview on 05/24/2023 at 7:40 AM, Resident 3 stated that they used the CPAP at night. Resident 3 stated that they put the CPAP mask on themselves. Resident 3 stated that the Care Managers filled the CPAP reservoir with the distilled water. Resident 3 stated that the Care Managers cleaned the mask and the air hose. Observation on 05/24/2023 at 7:58 PM, showed Staff L, Care Manger, used their care tablet to review Resident 3's care tasks and ISP. During an interview at this time, Staff L stated that they were unable to find any information that showed Resident 3 used a CPAP. Staff L stated that the Care Managers used a sanitation cloth to clean the CPAP mask and the licensed nurses cleaned the CPAP hose. During an interview on 05/24/2023 at 2:53 PM, Staff B, Registered Nurse, Resident Care Director, stated that when they completed Resident 3's initial assessment, Resident 3 did not use a CPAP machine. Staff B stated that the Reminiscence Care Coordinator was responsible for communicating to the nurses when residents obtain new medical devices. Staff B stated they were unsure of when Resident 3 started with the CPAP. Staff B stated that information about the CPAP machine, instructions for when it was used and how it was cleaned needed to be in the ISP. RESIDENT 4 Observation on 05/22/2023 at 2:54 PM and 05/24/2023 at 8:59 AM showed Resident 4 asleep in their room. On 05/23/2023 at 8:00 AM, 05/23/2023 at 12:05 PM, and 05/24/2023 at 8:00 AM, observations showed Resident 4 asleep during mealtimes. Observations showed Staff L continuously woke, cued, and fed Resident 4 breakfast and lunch. Further observation showed Resident 4 open their mouth to accept food while their eyes remained closed. Review of Resident 4's ISP dated 02/28/2023 showed a diagnosis of and . The ISP showed that Resident 4 had altered respiratory status and had difficulty breathing due to obstructive sleep apnea. The ISP showed Resident 4 used a CPAP machine and the supplies were kept at the bedside. The ISP did not provide the Care Managers with instructions on how to operate the CPAP, This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 who was responsible to clean the CPAP, who filled the reservoir or if assistance was required to place the CPAP mask on Resident 4. During an interview on 05/24/2023 at 12:56 PM, Staff M stated that Resident 4's ISP provided no clear instructions about the CPAP to show who was responsible to clean the attachments, fill the reservoir and place the mask on the resident in Resident 4. Staff M confirmed the CPAP information needed to be in Resident 4's ISP. 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, Sunrise of Redmond 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 WAC 388-78A-2464 Background checks Process Background authorization form. Before the assisted living facility employs, directly or by contract, an administrator, staff person or caregiver, or accepts any volunteer, or student, the home must: (1) Require the person to complete a DSHS background authorization form; and (2) Submit to the department's background check central unit, including any additional documentation and information requested by the department. This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to complete a Department of Social and Health Services (DSHS) background check (BGI) for 2 of 3 sampled contracted private home care aides (HCA; Collateral Contact 1 [CC1] and Collateral Contact 2 [CC2]). This failure placed Resident 5 at risk for potential abuse and neglect from caregivers with unknown background check results. Findings included… Review of the facility's "Assisted Living Facility Resident Characteristic Roster", dated 05/22/2023, showed that the facility admitted Resident 5 in 2022. Review of the facility's document titled "Companion Care, Inc. - 7 Day Client Schedule", dated 05/24/2023, showed Resident 5 hired three private Home Care Aides that included Collateral Contact 1 (CC1) and Collateral Contact 2 (CC2). The document showed the This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 private HCAs worked a split daily schedule: 8:00 AM – 11:00 AM and 7:00 PM – 10:00 PM. The document showed that CC1 worked on 05/22/2023 and 05/23/2023 and CC2 worked on 05/24/2023 and 05/25/2023. Review of CC1's background check obtained from the home care agency showed the agency completed a Washington State Patrol (WSP) "Washington Access to Criminal History (WATCH)" report, dated 05/26/2022. The report showed no record found. Review of a facility email titled "DSHS Background Check" (BGI), dated 06/01/2023, showed the home care agency confirmed CC1's first day of work for Resident 5 in the facility was 04/16/2023. There was no documentation that showed the facility completed a DSHS BGI when CC1 started work with Resident 5 in April 2023. Review of CC2's background check obtained from the home care agency showed the agency completed a Washington State Patrol (WSP) "Washington Access to Criminal History (WATCH)" report, dated 05/24/2023. The report showed no record found. Review of a facility email titled "DSHS Background Check", dated 06/01/2023, showed the home care agency confirmed CC2's first day of work for Resident 5 in the facility was 02/24/2023. There was no documentation that showed the facility completed a DSHS BGI when CC2 started work for Resident 5 in February 2023. During an interview on 05/24/2022 at 2:35 PM, Staff A, Executive Director, identified one Assisted Living Resident, Resident 5, who employed private HCAs from a contracted home care agency. Staff A stated that Resident 5 employed private HCAs in coordination with the facility for care and services. Staff A stated that the home care agency conducted the background check on the private HCAs and provided the facility with the background check results. Staff A stated that they were unaware the facility was responsible to complete a BGI through DSHS background check central unit for the private HCAs. Staff A further stated that they were unaware CC1 and CC2 did not have a DSHS BGI result when they started work at the facility with Resident 5. Observation on 05/25/2023 between 8:30 AM and 9:30 AM showed that CC1 assisted Resident 5 with showering, dressing, and catheter care. During an interview at this time, CC1 stated that they were a private home care aide. CC1 stated that they worked two hours in the morning and two hours in the evening, every day. CC1 stated that they provided Resident 5 morning care and medication assistance. CC1 further stated that another home care aide worked in the evening and assisted with the evening care and medications. 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, Sunrise of Redmond 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. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Administrator (or Representative) Date WAC 388-78A-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (b) Develop and implement systems that support and promote safe medication service for each resident. This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to ensure 2 of 2 sampled Staff (Staff U, Licensed Practical Nurse, Wellness Nurse, and Staff V, Registered Nurse, Wellness Nurse) documented the blood sugar checks and insulin administration on the electronic Medication Administration Record for 1 of 1 sampled resident (Resident 6). This failure placed Resident 6 at risk of potential medication errors and adverse medical outcomes. Findings included… Review of the facility's document titled "Medication Oversight Program V3.0", dated April 2023, showed that the facility followed all applicable state/province laws and regulations and accepted standards of practice related to medications and medication administration. The document showed that the facility weekly and monthly reviewed electronic Medication Administration Record (eMAR)/Orders Dashboard and Orders Portals to ensure medications were available, administered and documented and to identify issues that needed to be corrected immediately. Review of Resident 6's "Individual Service Plan (ISP)" dated 02/14/2023, showed that the facility admitted Resident 6 in 2023, with a medical diagnosis of . The ISP showed that the facility provided insulin administration. Review of Resident 6's March 2023 and April 2023 electronic Medication Administration Records (eMAR) showed that Resident 6's received Insulin (a medication used to control high blood sugar), injected subcutaneously (inject under the skin) before meals, per sliding scale order (physician's order of the prescribed dose of insulin given, based on blood glucose levels). The eMARs showed no documentation of blood sugar check results and insulin doses given on 03/08/2023 at 4:30 PM, on 04/13/2023 at 11:30 AM, on 04/21/2023 at 4:30 PM, and on 04/22/2023 at 4:30 PM. The eMAR showed no explanation about why the blood sugar checks and insulin administrations were undocumented or if Resident 6 refused. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Observation on 05/24/2023 at 11:10 AM showed Staff T, Registered Nurse, Wellness Nurse, performed a blood sugar check and administered an insulin injection for Resident 6. During an interview at this time, Staff T stated that Resident 6 was unable to self-administer blood sugar checks and insulin injections. Staff T stated that they administered Resident 6's blood sugar checks and administered insulin injections. Staff T stated that after completion of the blood sugar checks and insulin administration, Staff T documented the information in the eMAR. During an interview on 05/24/2023 at 2:50 PM, Staff B, Registered Nurse, Resident Care Director, stated that the facility's Wellness Nurses completed Resident 6's the blood sugar checks and administered the insulin injections. Staff B stated that they were unaware of the four missing sign- offs of the blood sugar check and insulin administration in Resident 6's March 2023 and April 2023 eMARs. During a follow-up interview on 05/25/2023 at 10:00 AM, Staff B stated that they conducted the medication review every month. Staff B stated that they did not complete a medication review for the month of April 2023. Staff B stated that they were unaware of the missing documentation for Resident 6's the blood sugar check results and insulin injections. 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, Sunrise of Redmond 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 WAC 388-78A-2466 Background checks Washington state name and date of birth background check Valid for two years National fingerprint background check Valid indefinitely. (1) A Washington state name and date of birth background check is valid for two years from the initial date it is conducted. The assisted living facility must ensure: (a) A new DSHS background authorization form is submitted to the department's background check central unit every two years for all administrators, caregivers, staff persons, volunteers and students; and This requirement was not met as evidenced by: Based on interview and record review the facility failed to ensure 1 of 6 sampled staff (Staff This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 A, Executive Director) completed the Washington State name and date of birth background check every two years. This failure placed the 59 residents at risk for potential abuse, neglect, or exploitation by a staff with an unknown national background checks. Findings included… Review of Staff A's facility's personnel records showed the facility hired Staff A on 09/17/2021. Staff A completed the initial Washington State Name and Date of Background inquiry (BGI) on 05/19/2021. The initial background check expired on 05/19/2023. Further review of Staff A's personnel records showed Staff A completed a new BGI on 05/25/2023, 6 days after the expiration of the initial BGI. During an interview on 05/25/2023 at 1:00 PM, Staff Q, Business Office Coordinator stated that they maintained the facility's personnel records. Staff Q confirmed that Staff A's two-year BGI was submitted late. 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, Sunrise of Redmond 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 WAC 388-78A-3090 Maintenance and housekeeping. (1) The assisted living facility must: (a) Provide a safe, sanitary and well-maintained environment for residents; (b) Keep exterior grounds, assisted living facility structure, and component parts safe, sanitary and in good repair; This requirement was not met as evidenced by: Based on observation, interview, and record review, the Assisted Living Facility (ALF) failed to ensure an environment free of hazards. This placed 59 residents at risk of injury or harm related to potential trip and fall, and exposure to harmful chemical products. Findings included… This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Review of facility's document titled, "Housekeeping PM (preventive maintenance) Policy," dated 10/30/2015, showed that the facility staff performed reoccurring tasks and periodic project cleaning tasks assigned by the facility's automated preventive maintenance system. The document showed that the preventive maintenance standards included the facility's physical asset, which were the resident's suites, common areas, and back-of-house areas. Observation on 05/22/2023 during the environmental tour at 11:45 AM, showed a pallet stacked with hazardous chemicals and paints, a metal picnic table, and old metal lockers, in an area that was assigned for parking. Observation showed multiple 5-gallon containers of hazardous chemicals, which included oxidizer and corrosive liquids. The containers had no protective cover and no warning signs posted to alert of potential physical and health hazards. Additionally, there were six old metal lockers on the ground with exposed, sharp metal feet. There were also two freestanding metal lockers near the sidewalk. The standing lockers had the potential to be tipped over or fall on residents who walked by. There was no caution sign to warn residents of this potential safety hazard. Further observation showed a metal picnic table obstructed a designated fire lane. This obstruction had the potential to prevent emergency responders' easy access to the building. During an interview on 05/22/2023 at 11:50 AM, Staff R, Maintenance Coordinator stated that the hazardous chemicals were previously removed from the facility's storage area. Staff R stated that the chemicals were scheduled for disposal by the environmental waste services in three days. Observation on 05/24/2023 at 3:26 PM, showed two residents using a walker and a companion of two other residents walked around the building. During an interview at this same time, Staff S, Assisted Living Activities and Volunteer Coordinator confirmed that there were residents that independently walked around the premise. 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, Sunrise of Redmond 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 WAC 388-78A-2090 Full assessment topics. The assisted living facility must obtain sufficient information to be able to assess the capabilities, needs, and preferences for each resident, and must complete a full assessment addressing the following, within fourteen days of the resident's move-in date, unless extended by the department for good cause: This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 (6) Significant known behaviors or symptoms of the individual causing concern or requiring special care, including: (e) Other safety considerations that may pose a danger to the individual or others, such as use of medical devices or the individual's ability to smoke unsupervised, if smoking is permitted in the assisted living facility. This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to ensure 1 of 1 resident (Resident 3), who used a medical device, was assessed to safely and properly use the device. The facility also failed to ensure the device was securely installed for safe use and to prevent possible entrapment. These failures placed Resident 3 at risk for potential entrapment and injury. Findings included... BED SIDE RAIL Review of the Department of Health and Social Services (DSHS) document titled "Dear Assisted Living Facility Administrator", dated 05/15/2013, showed Assisted Living Facility Providers were issued this letter related to the safety risks associated with the use of all medical devices. The letter listed some examples of medical devices with known safety risks when used include transfer poles, Posey or lap belts, and side bed rails. Potential risks of medical devices may include strangling, suffocating, bodily injury, skin bruising, cuts, scrapes, agitation, feeling isolated or unnecessarily restricted. Review of the facility's undated policy titled "North America Assistive Devices" showed that the facility's corporation did not approve the utilization of side/bed rails in their communities. The policy showed that devices were defined as any device designed or adapted to assist resident with physical or emotional limitation to perform actions, tasks, and activities. The policy showed action steps to be taken prior to installation of an assistive devices included step 1: The licensed Nurse "will assess the resident. This assessment is to include a review of the resident's: a. bed mobility; b. ability to transfer between positions, to and from bed or chair to stand and toilet; c. cognition and the ability to use an assistive device independently". The policy showed the assessment was kept in the electronic health record of the resident. Further review showed the licensed Nurse would outline the reason for the use of the assistive device, monitoring and resident specific care instructions in the progress notes and the Individual Service Plan (ISP). Record review of the facility's undated document titled "Resident Characteristics Roster" showed that the facility admitted Resident 3 in of 2022. The Characteristics Roster showed no documentation that Resident 3 used a medical device (bed side rail). The Characteristics Roster showed that Resident 3 resided in the secured Memory Care unit. Review of Resident 3's undated "Progress Notes" showed no record that Resident 3 admitted with a bed side rail attached to the hospital bed. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Review of the Resident 3's facility document titled "Individual Service plan" (ISP), dated 04/21/2023, showed no documentation that Resident 3 used a bed side rail. Review of Resident 3's undated medical records found no documentation of a bed side rail assessment. Review of Resident 3's initial "general assessment", dated 05/10/2023, showed Resident 3 was diagnosed with and . The assessment also documented Resident 3 had a history of falls. The assessment showed Resident 3 was alert, oriented to place, forgetful, confused about the environment, unable to remember recent events and unable to remember specific events. The general assessment did not identify Resident 3 used a bed side rail. During the facility tour on 05/22/2023 at 9:41 AM, observation of Resident 3's room showed a Resident 3's used a hospital bed. Observation showed a bed side rail attached to the hospital bed. Observation on 05/23/2023 at 12:32 PM showed a half bedrail, 37 inches in length by 19 inches high, on the open side of Resident 3's hospital bed. The other side of the bed was pushed up against the wall. During an interview on 05/24/2023 at 7:49 AM, Resident 3 stated that the bed side rail fastened to their hospital bed was used to "lock me in bed" so they could not get out. Resident 3 stated that the staff locked them in bed at night and let them out in the morning. During a second interview on 05/25/2023 at 7:50 AM, Resident 3 stated that they wanted the bed side rail for bed mobility. During an interview on 05/24/2023 at 7:58 AM, Staff L, stated that Resident 3 used the bed side rail to keep them from falling out of bed. Staff L stated that Resident 3 had upper body paralysis. Staff L stated that Resident 3 also used the bed side rail to exercise in bed, turning themselves from side to side. During this same time, observation of Staff L's electronic tablet showed specific care tasks assigned for Resident 3. The tablet also showed Resident 3's ISP. Review of the assigned tasks and the ISP showed no documentation that Resident 3 used a bed side rail. During an interview on 05/24/2023 at 2:40 PM, Staff N, Care Manager, stated that Resident 3 used the bed side rail to move around in the bed. Staff N stated that there were times Resident 3 placed their leg on the side of the bed and the bed side rail prevented Resident 3 from a fall. out. Staff N stated that when Resident 3 required any transfer assistance, Resident 3 used the bed side rail to support themselves to stand-up. During an interview on 05/24/2023 at 12:56 PM, Staff M, Reminiscence Coordinator, stated that they were unaware Resident 3 had a bed side rail attached to the bed. Staff M stated that the Care Managers were responsible to communicate with Staff M when a resident in the secured Memory Care unit used a medical device, such as a bed side rail. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2464 Compliance Determination # 24508 Plan of Correction Sunrise of Redmond Completion Date Page of 19 Licensee: Sunrise Senior Living Management Inc 06/20/2023 Staff M stated that they were unaware if a licensed nurse completed an assessment for the bed side rail or if it was noted in Resident 3's individualized service plan. During an interview on 05/24/2023 at 2:53 PM, Staff B, Registered Nurse, Resident Care Director, stated that they were unaware if an assessment for Resident 3's bed side rail was completed when Resident 3 admitted to the facility. Staff B stated that they were unaware if Resident 3's ISP identified the bed side rail. 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, Sunrise of Redmond 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 This document was prepared by Residential Care Services for the Locator website.