Cordata Court, Assisted Living & Memory Care.

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

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Cordata Court, Assisted Provider Type: Assisted Living Facility Living & Memory Care License/Cert.#: 2481 Intake ID: 190081 Compliance Determination #: 64318 Region/Unit #: RCS Region 2 / Unit J Investigator: Helen Fisher Investigation Date(s): 08/20/2025 through 09/02/2025 Complainant Contact Date(s): Allegation(s): The Named Resident (NR) had an injury with unknown source. Investigation Methods: Sample: Total residents: 72 Resident sample size: 6 Closed records sample size: 0 Observations: Residents. Environment. Interviews: Residents, Nursing Staff, Direct Care Staff. Regional Director of Operations (RDO). Record Reviews: Resident's care plan, progress notes. Investigation Summary: Review of the investigative report showed that the ALF responded in a timely manner, assessed the NR and ruled out abuse and neglect. The NR had a history of getting down and crawling the floor and attempted to get self off the floor. However, during observations two residents rooms appeared unkept, unclean with foul urine odor. Failed practice was identified. A citation was written for non-compliance with Washington Administrative Code 388-78A-3090 Maintenance and housekeeping. 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.

—: WA DSHS report: Investigations (07/2024)

—: WA DSHS report: Investigations (06/2024) —: WA DSHS report: Investigations (06/2024) —: WA DSHS report: Investigations (06/2024) —: WA DSHS report: Investigations (06/2024)

—: WA DSHS report: Inspections (04/2024) —: WA DSHS report: Investigations (04/2024)

This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Cordata Court, Assisted Provider Type: Assisted Living Facility Living & Memory Care License/Cert.#: 2481 Intake ID: 93223 Compliance Determination #: 28530 Region/Unit #: RCS Region 2 / Unit A Investigator: Judith Mellon Investigation Date(s): 08/23/2023 through 10/04/2023 Complainant Contact Date(s): Allegation(s): 1) A Named Resident (NR) was believed to be neglected by an unknown Staff person and was not checked on by Assisted Living Facility (ALF) Staff. 2) The NR was lying in bed in urine as if not changed during the night. 3) The Staff did not want to get the NR up out of bed and take the NR to the dining room. 4) The Staff stated the NR was difficult to get out of bed because the NR was aggressive. 5) The NR had lice and was put in quarantine. 6) The Staff may have been mentally abusing the NR by restricting social activities. 7) The NR was not receiving care when outside and providers are not there. 8) The NR's living quarters were never clean, there was a urine and feces odor in the NR's bathroom. 9) The NR had no fitted sheet and was lying on plastic with a few throw blankets beside the NR. 10) The Staff take the NR's meal order and then it takes 45 minutes to get food while the staff take breaks. Investigation Methods: Sample: Total residents: 56 Resident sample size: 9 Closed records sample size: 1 Observations: Named Resident and Named Resident's living quarters, staff response to resident care needs, NR shower, transfers and care, medication administration, Named Resident and Staff interactions Interviews: Named Resident, family, outside agency, outside provider, Executive Director, Assisting Health and Wellness Director/Nurse, Resident Care Coordinator, Caregivers, Medication Technician Record Reviews: NR medical records including electronic medication administration records from March 2023 through August 2023, Physician faxes, facility policies This document was prepared by Residential Care Services for the Locator website. Investigation Summary: 1, 7) The NR was observed during an unannounced visit to be well groomed, clean and neatly dressed sitting in a recliner chair watching television with an outside Agency Staff present. The NR was observed to be assisted by ALF Staff for a shower and hygiene care prior to outside Agency Staff arriving to the NR’s living quarters. No findings. 2) The NR was observed to be lying in bed incontinent of urine in the morning. A Citation was written for WAC 388-78A-2160. 3) The NR was observed to be lying in bed in the morning and the NR was not at the Dining Room for meals. The NR was observed to have a take-out container brought to the NR’s living quarters. Staff were notified by Nursing Staff requesting to know why the NR was not brought down to breakfast in the morning. A Citation was written for WAC 388-78A-2160. 4) The NR was observed to be pleasant, smiling and attempting to engage in conversation with ALF Staff. No aggression was observed. An ALF Caregiver stated that the NR was not at the dining room because the NR was aggressive. A Citation was written for WAC 388-78A-2160. 5) The NR was assessed by the Regional Nurse to have lice. The ALF Staff notified family and the Physician. The NR stayed in the NR's living quarters to prevent the spread of lice. The NR's Physician wrote a prescription to treat the NR with Rid Nix, however the prescription was not sent to the ALF. The family purchased an over-the-counter treatment and applied the treatment. No findings. 6) ALF documentation showed the NR refused activities and requested to stay in the NR’s living quarters. No mental abuse observed. The NR denied any abuse by Staff. No findings. 8) The NR’s kitchenette floor was sticky to walk on and the NR’s bathroom had a toilet bowl unclean with feces. No urine or feces odor was present in the NR's living quarters. A Citation was written for 388-78A-3090 (1)(a)(c). 9) The NR was observed lying in bed. The bed had a fitted sheet, incontinence pad and blankets. No findings. 10) The NR's negotiated service agreement showed the NR was to be escorted to all meals. The NR was observed to not attend the dining room for breakfast. A breakfast take out container was observed carried into the NR's living quarters. Staff stated the NR did not go to breakfast. A Citation was written for 388-78A-2160. 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 3906-172nd St NE, Suite #100, Arlington, WA 98223 10/09/2023 Licensee: PSL Associates, LLC Cordata Court, Assisted Living & Memory Care 4415 Columbine Dr Bellingham, WA 98226 RE: Cordata Court, Assisted Living & Memory Care License # 2481 Dear Administrator: The Department completed a full inspection and a complaint investigation of your Assisted Living Facility on 10/04/2023 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: This document was prepared by Residential Care Services for the Locator website. PSL Associates, LLC Cordata Court, Assisted Living & Memory Care # 2481 10/04/2023 Page 2 of 34 Kimberley Ripley, Field Manager Residential Care Services 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 Aging and Long-Term Support Administration Residential Care Services PO Box 45600 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 Residential Care Services Enclosure This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website.