The Cottages of Covington.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . STATE OF WASH! GTON DEPARTMENT OF SOCIAL AND HEALT H SERVJ CES AGJNG AND LONG-TERM SUPPORT ADMINISTRAT!ON 20425 12nd Avenlle S, Suite 400, Kent, WA 9B031 Statement of Def1c1enc1es License#. 2594 Compliance-Oeterm1nahon #59637 Plan of Correction The Cottages of Covington Completion: Date You are required to be in compliance at all times with all licensing laws and regulations to maintain your Assisted Living Facility license. The department compteted data collection for an unannounced on-site complaint investigation on 05/13/2025 of: The Cottages of Covington 17012 SE Wax Road Covington, WA 98042 This document references the following complaint number(s): 179052, 178223, 178053, 175759 The following sample was selected for review during the unannounced on-site visit: 2 of 59 current residents and 1 former residents. The department staff that investigated the Assisted Living Facility: Harrison Udoye, Community Complaint Investigator From: DSHS, Aging and long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 . Statement of Deficiencies License #. 2594 Compliance Determination #59537 Plan of Correction The Cottages of Covington Completion Date As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. 07/02/2025 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. epresentat[ve) Date WAC 388-78A-2100 Ongoing assessments. (2) The assisted living facility must: (b) Complete an assessment specifically focused on a resident's identified problems and related issues: (i) Consistent with the resident's change of condition as specified in WAC 388-78A-2120; (ii) \/\/hen the resident's negotiated service agreement no longer addresses the resident's current needs and preferences; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to complete an updated assessment for 1 of 1 resident (Resident 1) when there were changes in the resident's overall condition. This failure placed Resident 1 at risk of a decline in their medfcal condition, severe dehydration, and skin breakdown that was prone to infection. Findings Included ... Review of facility undated document titl'ed, "Admission Record", showed the facility admitted Resident 1 on /2025. Resident 1 admitted with multiple diagnoses which included: due to a known physiological condition (a state of normal: functioning of the body) without behavioral disturbance; and . Statement of Deficiencies License#. 2594 Compliance Determination #5~537 Plan of Correction The Cottages of Covington Completion Date not due to substance or known physiological condition. Review of facility's undated document titled "Service Plan Report" showed that upon admission, Resident 1 required total assistance from staff with all care needs. The care plan showed Resident 1 was unable to make their needs and preferences known and thatfacility staff needed to anticipate Resident 1 's needs. The care plan showed that when Resident 1 was admitted to the facility on /2025, Resident 1' s skin was intact. The care plan showed that Resident 1 requlred total assistance from facility staff to maintain skin integrity. The plan showed no documentation or instructions to staff to complete routine daily or weekly skin assessments on Resident 1. The plan showed that facility staff were to notify Staff B, Director of Nursing, when Resident 1 required more assistance with care needs and repositioning. Review of Resident 1' s records showed there was no documentation anywhere that showed staff completed any daily, or weekly, skin assessment checks prior to 05/1 't/2025. There was no documentation anywhere that showed staff reported Resident 1 needed more assistance with care Review of Resident 1' s Progress Notes, dated 04/30/2025, showed that Resident 1 was drowsy during lunch time and had a difficult time eating regular food. The notes documented that Staff 8 contacted Resident 1 's Power of Attorney (POA) and requested a change in Resident 1 's diet, from a regular diet ta a pure-texture diet (a type of modified diet where all foods are blended or processed into a smooth, pudding-like consistency). There was documentation in the progress notes and in the service plan that showed the diet was changed. There was no documentation in the progress notes or the service plan that showed the change in the diet worked to meet Resident 1's nutritional needs. Review of Resident 1' s Progress Notes, dated 5/13/2025, showed that when staff discovered the open wounds on both sides of Resident 1 's buttocks, Resident 1 expressed no signs of pain or discomfort. The progress notes showed Resident 1 was sentto the hospital an 05/12/2025 due to generalized weakness, high temperature, and the pressure wounds. During an interview on 05/13/2025 at 11: 33 P.,M, Staff A, Assistant Executive Director, stated that on 05/11/2025, while in the facility, Resident 1 spent most of the day in their recliner chair white family visited. Staff A stated that when the care staff assisted Resident 1 with peri care, staff noticed the open wounds on both sides of Resident 1' s buttocks. Staff A stated that the care staff immediately n otlfi e d Staff 8. During an interview on 06/09/2025 at 9:37 AM, Staff B stated that on /2025, when the facility admitted Resident 1 to the memory care unit, an assessment was completed. Resident 1' s skin was intact. Staff B stated that a few days affer admission, Resident 1 seemed to be drowsier and sleepier than when they first admitted ta the . Statement of Deficiencies License #:. 2594 Compliance Determination #c59537 Plan of Correction The Cottages of Covington Comple1ion Date facility. Staff B notlfied both Resident 1 's representative and the facility physician. The facillty physician ordered a reduction in Resident 1 's psych medications. Staff 8 stated that the medication change was only effective for a couple of days. Staff B stated that when the facility staff notitied them of open wounds on Resident 1 's buttocks, Staff B determined that Resident 1 had developed pressure wounds (an open area characterized by full-thickness skin loss., extending into the fatty tissue without exposing muscle, tendon, or bone). Staff B immediately initiated a treatment plan. Staff B stated that on 5/11/2025, they opened an internal investigation to try and determine how the wounds started. The investigation determined that one of the care staff did not assess and report the wounds to facility management. During an interview on 06/11/2025 at 10: 15 AM, Co!lateral Contact 1 (CC1, Resident 1 representative) stated that Resident 1 was a patient at for four months before Resident 1 admission to the memory care unit. Resident 1 was ambulatory with minimal assistance, unable to make needs known, incontinent (unable to voluntarily control retention of urine or feces ln the body) and totally dependent on care staff for all Activity of Daily Livings {ADLs- basic self-care tasks that are essential for maintaining independence and living well far example bathing, dressing, toBeting eating and getting in and out of bed). CC1 stated that Resident 1' s skin was intact without any redness or open wounds prior to transferring to the memory care unit. Plan/Atte-station Statement t hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, The C~a\£ of1&f1 o-gton is or ~to_ . will be in compliance with this law and/ or regulation on (Date) - - In addition, I will implement a system to monitor and ensure continued compfiance with this requirement. Date .

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. This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: The Cottages of Covington Provider Type: Assisted Living Facility License/Cert.#: 2594 Intake ID: 132199 Compliance Determination #: 43792 Region/Unit #: RCS Region 2 / Unit D Investigator: Harrison Udoye Investigation Date(s): 07/08/2024 through 07/26/2024 Complainant Contact Date(s): Allegation(s): Failure to notify Home and Community Services when Named Resident was out of facility Investigation Methods: Sample: Total residents: 50 Resident sample size: 1 Closed records sample size: 0 Observations: Residents Activities Resident care equipment Resident rooms Staff to resident interactions Resident to resident interactions Medication administration Interviews: Identified staff Family members Social services staff Maintenance staff Business office manager Record Reviews: Medical records State reporting log Incident investigation Facility policies Personnel files Staff training records Investigation Summary: Report of facility failure to notify Home and Community Services (HCS) when a resident was out of the Assisted Living Facility for medical leave. Interview and record review showed facility failed to report to the appropriate agencies for any hospitalization when over 24 hours from the Assisted Living Facility (ALF). Facility newly hired staff was not familiar with the required reporting timeline This document was prepared by Residential Care Services for the Locator website. to HCS. Facility failed practice identified. Consultation issued. 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.

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.