Cogir of Bothell.

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Cogir of Bothell Provider Type: Assisted Living Facility License/Cert.#: 2623 Compliance Determination #: 65071 Intake ID: 192845 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 09/03/2025 through 10/08/2025 Complainant Contact Date(s): Allegation(s): 1. The Named Resident (NR) was found on the floor, without breath and pulseless at the Assisted Living Facility (ALF). Investigation Methods: Sample: Total residents: 50 Resident sample size: 1 Closed records sample size: Observations: Residents Staff to resident interactions Resident to resident interactions Courtyard Interviews: Identified resident Nursing staff Residents Record Reviews: State reporting log Incident investigation Facility policies Resident Records Investigation Summary: 1. In an interview, the staff found the NR on the floor unresponsive. The Medication Technician initiated Cardiopulmonary Resuscitation (CPR), until the NR's code status was determined. The ALF staff made all the appropriate notifications, including a call to law enforcement and the NR's family representative. The ALF failed to ensure all staff had current CPR certifications as per their policy. See Statement of Deficiency WAC 388-78A-2474 (2)(d). Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written This document was prepared by Residential Care Services for the Locator website. N/A 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.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 AMENDED 12/07/2023 Cogir Management USA Inc Cogir of Bothell 10605 NE 185th St Bothell, WA 98011 RE: Cogir of Bothell # 2623 Dear Administrator: This document references Compliance Determination 32352 (12/07/2023), which included complaint number(s) 103969, 105538, 106495. The Department completed a complaint investigation of your Assisted Living Facility on 12/07/2023 and found that your facility does not meet the Assisted Living Facility requirements. The department staff who did the inspection and provided consultation: Michelle Mcglon, Nursing Consultant Institutional Consultation: WAC 388-78A-2600 Policies and procedures. (2) The assisted living facility must develop, implement and train staff persons on policies and procedures to address what staff persons must do: (k) To prevent and limit the spread of infections consistent with WAC 388-78A-2610 ; The Assisted Living Facility failed to implement their COVID-19 (COVID-19 is an infectious disease by a new virus causing respiratory illness with symptoms including cough, fever, new or worsening malaise, headache, or new dizziness, nausea, vomiting, diarrhea, loss of taste or smell, and in severe cases difficulty breathing that could result in severe impairment or death) policy which states all staff should wear a mask while in the community during an outbreak. This placed the residents at risk of exposure to a This document was prepared by Residential Care Services for the Locator website. Cogir of Bothell # 2623 12/07/2023 Page 2 of 2 communicable virus. You Must: • Begin the process of correcting the deficiency or deficiencies immediately; and • Complete correction as soon as possible. You Are Not: • Required to submit a plan-of-correction for the deficiency or deficiencies found. The Department May: • Inspect the facility to determine if you have corrected all deficiencies. You May: • Contact me for clarification of the deficiency or deficiencies found. 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 (425)670-6070. Sincerely, Jamie Singer, Field Manager Region 2, Unit J Residential Care Services This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Cogir of Bothell Provider Type: Assisted Living Facility License/Cert.#: 2623 Compliance Determination #: 32352 Intake ID: 105538 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 11/09/2023 through 12/07/2023 Complainant Contact Date(s): Allegation(s): 1. The Assisted Living Facility (ALF) had resident test positive for COVID. Investigation Methods: Sample: Total residents: 37 Resident sample size: 3 Closed records sample size: Observations: Residents Dining Staff to resident interactions Interviews: Nursing staff Record Reviews: Line list Characteristic Roster Facility policies Investigation Summary: 1. Interview and record review showed the ALF had infection control policies and procedures in place. Staff and residents tested and monitored for COVID-19 symptoms. The ALF met reporting requirements and followed Department of Health and Center for Disease Control guidance and Local Health Jurisdiction recommendations. 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. Residential Care Services Investigation Summary Report Provider/Facility: Cogir of Bothell Provider Type: Assisted Living Facility License/Cert.#: 2623 Compliance Determination #: 32352 Intake ID: 106495 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 11/09/2023 through 12/07/2023 Complainant Contact Date(s): Allegation(s): 1. The Named Resident (NR) was found on the floor, after the Assisted Living Facility (ALF)'s monitoring system was triggered. 2. The Named Staff (NS) did not provide incontinence care to the NR. 3. The NR tested positive for COVID and the NS did not wear the proper Personal Protective Equipment (PPE), while providing care. Investigation Methods: Sample: Total residents: 37 Resident sample size: 3 Closed records sample size: Observations: Residents Staff to resident interactions Resident to resident interactions Interviews: Nursing staff Record Reviews: Incident investigation Resident Records Investigation Summary: 1. In an interview, the Executive Director(ED) stated that the NS had sat the NR on the floor. The NR had no injuries. The NS was terminated by the ALF. The NR's care plan had appropriate fall prevention measures in place. 2. In an interview, the Health and Wellness Director stated that the employee was terminated and no longer providing care to the ALF residents. Observation showed the residents were clean. In interviews, sampled residents and representatives had no concerns with incontinent care. 3. Observation and interview, showed the ALF failed to implement their COVID-19 policy, which states all staff should wear a mask and appropriate PPE, while in the community during an outbreak. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written This document was prepared by Residential Care Services for the Locator website. Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website.