Cogir of Edmonds.

Residential Care Services Investigation Summary Report Provider/Facility: Cogir of Edmonds Provider Type: Assisted Living Facility License/Cert.#: 2624 Compliance Determination #: 64637 Intake ID: 191817 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 08/25/2025 through 09/24/2025 Complainant Contact Date(s): Allegation(s): 1. The Named Resident (NR) was found unresponsive lying outside of the Assisted Living Facility (ALF), resulting in the paramedics to perform Cardiopulmonary Resuscitation (CPR) and determined the NR was deceased. Investigation Methods: Sample: Total residents: 65 Resident sample size: 2 Closed records sample size: 1 Observations: Residents Resident rooms Staff to resident interactions Balcony and courtyard area Interviews: Nursing staff Family members Fire Department Deputy Chief Record Reviews: State reporting log Incident investigation Facility policies Staff training records Resident Records Investigation Summary: 1. Interview and record review showed the ALF staff called 911, but failed to be near the NR, while on the phone with the 911 Operator or follow their instructions. Record review showed the NR did not have a POLST (Physician Orders for Life-Sustaining Treatment) which would indicate full code. This failure resulted in the paramedics to initiate life-saving measures, when they arrived onsite. Failed practice identified. See Statement of Deficiencies, dated 09/24/2025, WAC 388-78A-2120 (4) Conclusion / Action: This document was prepared by Residential Care Services for the Locator website. 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. Statement of Deficiencies License #: 2624 Compliance Determination # 64637 Plan of Correction Cogir of Edmonds Completion Date Page 2 of 7 Licensee: Cogir Management USA Inc 09/24/2025 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. Administrator (or Representative) Date WAC 388-78A-2120 Monitoring residents' well-being. The assisted living facility must: (4) Take appropriate action in response to each resident's changing needs. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to take appropriate life saving measures when 1 of 1 sampled resident (Resident 1) was found unresponsive on the ground outside of the facility. This failure resulted in Resident 1 not receiving life saving measures from ALF staff. Findings included… NOTE: According to cpr.heart.org, Cardiopulmonary Resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating. CPR, especially if performed immediately, can double or triple a cardiac arrest victims’ chance of survival. NOTE: According to the americanredcross.org, the person on the scene should do the following to increase a victim’s chance of survival. 2. If the person appears unresponsive, check for responsiveness, breathing, life-threatening bleeding or other life-threatening conditions. 4. Kneel beside the person. Place the person on their back on a firm, flat surface. 5. Use the correct body position, shoulders directly over your hands. 6. Give continuous compression (push hard and fast at least two inches at 100 to 120 compressions per minute). 7. Allow the chest to return to its normal position after each compression. Start compressions within 10 seconds after recognizing cardiac arrest - a sudden loss of all heart activity due to an irregular heart rhythm. Breathing has stopped or the person becomes unconscious and unresponsive. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 64637 Plan of Correction Cogir of Edmonds Completion Date Page 4 of 7 Licensee: Cogir Management USA Inc 09/24/2025 Staff C: 425-776-3600 Operator: Tell me exactly what happened? Staff C: (No response. Long Pause) Operator: Tell me exactly what happened? Staff C: (No response. Long Pause) Um. (No response. Long Pause) Operator: Hello? Staff C: Yes. Operator: Tell me exactly what happened? Staff C: We found resident on the floor at the balcony. Operator: How did they get to the floor? Staff C: I don’t know. (Speaking in the background. Inaudible) He’s okay? He’s not okay. He threw himself off of the balcony. Operator: He did what? I’m sorry. Staff C: Who? She went down with um…um. (Speaking in the background. Inaudible. Long pause) Operator: I’m sorry I couldn’t quite hear you. What did you say they did? Staff C: (long pause) Excuse me ma’am? Operator: Yes, I’m here. What did they do? Staff C: Um, we found him laying down at the balcony. (Two minutes and 16 seconds into the 911 call) Operator: On the balcony? Staff C: Yes. Operator: Are you with that patient now? Staff C: No. (Two minutes and 38 seconds into the 911 call) Operator: Okay. (pause) How old is the patient? Staff C: (No response) Operator: Ma’am? Hello? Staff C: Yes, Ma’am Operator: Hello? How old is the patient? Staff C: (No response) I’m calling them. I’m calling them (speaking to someone other than the 9-1-1 Operator) (Pause). Operator: Ma’am, How old is that patient? Staff C: Excuse me, Ma’am. Operator: Yes, how old is the patient, Ma’am? Staff C: Seventy something. Operator: Okay, is the patient male or female? Staff C: Male Operator: Okay, is he awake? Staff C: No Operator: Is he breathing? Staff C: I’m not with him. He’s at the balcony downstairs. Operator: I understand. Is he breathing? Staff C: I… I think so. (Three minutes and 32 seconds into the 911 call) Operator: Okay, just a second here. Is his breathing completely normal? Staff C: No. Operator: Is he still unconscious? Staff C: Yes. Operator: Okay. We are notifying the fire department. Stay on the line and I will tell you exactly what to do next. Are you right by him now? This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 64637 Plan of Correction Cogir of Edmonds Completion Date Page 5 of 7 Licensee: Cogir Management USA Inc 09/24/2025 (Four minutes and 4 seconds into the 911 call) Staff C: No, I’m not with him. Operator: Okay, get the phone as close to him as possible. Do it now and tell me when it is done. Staff C: Okay. Excuse me, what did you want me to do? Operator: I need you to get the phone as close to him as possible. Don’t hang up, do it now, and tell me when it is done. Staff C; Oh. I have to go and… (pause). Operator: We need to get the phone as close to him as possible to assess the situation. Staff C: (Long pause and no response). Operator: Are you able to get the phone close to him? Staff C: I’m going there now. (Five minutes and 0 seconds into the 911 call) (Pause no one is speaking for 56 seconds) Operator: Are you with the patient now, ma’am? Staff C: (No response) Staff C: He’s not breathing. (Six minutes and 12 seconds into the 911 call) Operator: Are you with him now? Staff C: Yeah. Operator: Okay, let’s carefully lay him flat on his back. Remove anything from under his head. Staff C: (inaudible) Oh my gosh. Oh my gosh. (whispering) Operator: Ma’am, we need to lay him flat on his back. Okay? Staff C: Okay. Operator: Listen carefully, I’ll tell you how to do chest compressions. Make sure he is flat on his back on the ground. Place the heel of your hand on the breastbone in the center of the chest, right between the nipples, put your hand on top of that hand. Staff C: Okay. Oh my gosh. (whispering) Operator: Okay, we’re going to pump the chest hard and fast, at least twice per second and two inches deep. Let the chest come all the way up in between the pumps. We’re going to do this until help can take over. Okay? Staff C: Okay Operator: Okay, we’re going to do this until help can take over. I want you to count out loud with me. So, I can count with you. Okay, we’re going to go at this pace 1, 2, 3, 4, 1, 2, 3, 4, 1, 2, 3, 4. Staff C: (Interrupts the Operator) What do you want me to do? Excuse me. Why am I counting 1, 2, 3, 4? Operator: We need to do chest compressions. I want you to place the heel of your hand on the breast bone in the center of the chest, between the nipples, put your other hand.. Staff C: (Interrupts the Operator during instructions for chest compressions) Am I supposed to touch him? Operator: You said, he was not breathing. So, we need to do chest compressions. Staff C: (Inaudible) Operator: Do you understand me so far? Staff C: Oh my gosh. (Inaudible) Operator: Hello? Staff C: Yes. Operator: Okay, so let me give you instruction. We will do this together, okay. Place the heel of your hand on the breastbone in the center of chest, right between the nipples. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 64637 Plan of Correction Cogir of Edmonds Completion Date Page 6 of 7 Licensee: Cogir Management USA Inc 09/24/2025 Put your hand on top of that hand. We’re going to pump the chest hard and fast at least twice per second. Staff C: And she’s not even (inaudible). Operator: What was that? Staff C: She put it back not even (inaudible) Operator: Ma’am, can you hear me? Staff C: Yes, Ma’am. Operator: Okay, are you able to do the chest compressions? Staff C: (Pause) No. Operator: I’m sorry. What was that? Is there somebody there that can do chest compressions? Staff C: (Inaudible, pause) Am I supposed to touch him? Operator: You said, he was not breathing. So, we need to start chest compressions. We need to let the chest come all the way up between the pumps. Staff C: (Inaudible) Operator: We’re going to do this until someone else can take over. Staff C: (No response) Operator: Do you understand me so far? Staff C: (No response) (Inaudible) They did not see you. Operator: Hello? Ma’am Operator: Hello? Staff C: Hello Ma’am. Operator: Are you able to do the chest compressions? Do you need the instructions again? Unknown person: Medics are here. (Nine minutes and 40 seconds into the 911 call) Staff C: (No response) Operator: Ma’am what’s happening? Staff C: Yeah. Operator: What’s happening? Staff C: Nothing, I’m okay. Operator: Is somebody there able to start chest compressions? Staff C: (No response) Operator: If you need to put me on speaker. I can give the instructions again Staff C: (No response) Operator: Do you understand me so far, ma’am? Hello? Hello? Staff C: Hello. Operator: Do you understand me so far on the instructions? Staff C: The paramedics are here. Operator: Okay, I will let you talk to them Call ends. Review of a Patient Care Record (PCR), dated 08/22/2025, showed that the Emergency Medical Technicians (EMT) arrived to the ALF at 7:38 AM. The PCR showed that EMTs found Resident 1’s extremities (arms and legs) were cold, but still malleable (easily influenced) with the trunk of the body still warm and pupils equal, round and reactive to light (a sign of brain activity). The PCR stated the EMT’s found Resident 1 on his right side and not laying on his back as instructed by the 911 operator. The PCR showed the EMT’s moved Resident 1 to a flat surface and initiated CPR compressions. The PCR showed Resident 1 had a pulse and respirations within eight minutes of initiating CPR. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 64637 Plan of Correction Cogir of Edmonds Completion Date Page 7 of 7 Licensee: Cogir Management USA Inc 09/24/2025 The PCR showed the EMT’s performed life saving measures for 20 minutes and 30 seconds before Resident 1 was pronounced deceased. In an interview, on 08/26/2025 at 10:47 AM, Staff A confirmed that she responded to Resident 1, outside the ALF, along with Staff B. Staff A confirmed, although she and Staff B were with Resident 1, and could provide the 911 operator with an assessment of Resident 1’s condition, she did not call or speak with the 911 operator or have any communication with Staff C during the 911 call. Staff A confirmed she, nor Staff B initiated CPR. Staff A stated that Resident 1 did not have a POLST (Provider Orders for Life-Sustaining Treatment), which meant Resident 1 was a full code (resident wishes to receive all possible life-saving interventions). In an interview, on 08/26/2025 at 2:15 PM, Staff B confirmed that she responded to Resident 1, outside the ALF, along with Staff A. Staff B confirmed, although she and Staff A were with Resident 1, and could provide the 911 operator with an assessment of Resident 1’s condition, she did not call or speak with the 911 operator or have any communication with Staff C during the 911 call. Staff B confirmed she, nor Staff A, initiated CPR. In an interview on 09/24/2025 at 9:09 AM, Collateral Contact 1 (CC1- Fire Department Deputy Chief) stated that EMTs would initiate CPR and life saving measures for a person if there were signs of life. 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, Cogir of Edmonds 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.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration PO Box 45600, Olympia, WA 98504-5600 October 3, 2025 ELECTRONIC-FACSIMILE Administrator Cogir of Edmonds 21500 72nd Ave W Edmonds, WA 98026 Assisted Living Facility License # 2624 Licensee: Cogir Management USA Inc IMPOSITION OF CIVIL FINE Dear Administrator: On September 24, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a Complaint Investigation at your facility. This letter constitutes formal notice of a civil fine on the license for your assisted living facility, also known as Cogir of Edmonds, located at 21500 72nd Ave W, Edmonds, 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 September 24, 2025. Civil Fine WAC 388-78A-2120 (4) Monitoring residents' well-being. $1,500.00 The licensee failed to take appropriate life saving measures when one resident was found unresponsive on the ground outside of the facility. This failure resulted in the resident not receiving life saving measures from facility staff. NOTE: This is the violation, which resulted in the fine; see the attached Statement of Deficiencies for any additional violations. Administrator Cogir of Edmonds License # 2624 October 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: Jamie Singer, Field Manager Region 2, Unit J 20311 52nd Avenue West Suite 100 Lynnwood, WA 98036 Phone: (253) 312-1446 / Fax: (206) 971-6791 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 Cogir of Edmonds License # 2624 October 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 $1,500.00 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 Cogir of Edmonds License # 2624 October 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 Jamie Singer, Field Manager, at (253) 312-1446. Sincerely, Matt Hauser Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 2, Unit J 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

This document was prepared by Residential Care Services for the Locator website. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 Cogir Management USA Inc Cogir of Edmonds 21500 72nd Ave W Edmonds, WA 98026 RE: Cogir of Edmonds License# 2624 Dear Administrator: This letter addresses Compliance Determination(s) 64980 (Completion Date 09/08/2025) and 62098 (Completion Date 07/15/2025). The Department completed a follow-up inspection of your Assisted Living Facility on 09/08/2025 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-2950-6, WAC 388-78A-2600-1-b The Department staff who did the on-site verification: Faith Le, NCI If you have any questions, please contact me at (253)312-1446. . s · Sincerely, Jamie Singer, Field Manag~ Region 2, Unit J Residential Care Services This document was prepared by Residential Care Services for the Locator website. ST ATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALT H SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 Statement of Deficiencies License #: 2624 Compliance Determination # 62098 Plan of Correction Cogir of Edmonds Completion Date Page 1 of 5 Licensee: Cogir Management USA Inc 07/15/2025 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 07/08/2025 and 07/10/2025 of: Cogir of Edmonds 21500 72nd Ave W Edmonds, WA 98026 The following sample was selected for review during the unannounced on-site visit: 8 of 59 current residents and O former residents. The department staff that inspected the Assisted Living Facility: Faith Le, NCI Erin Steinbrenner, Nursing Consultant Institutional From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit J 20311 52nd Ave W, Suite 100 Lynnwood, WA 98036 This document was prepared by Residential Care Services for the Locator website. :;tate or wash rngton 6/16 StattJrnent of Defkiiancies License #: 2624 Cornpliance Detern1ination # 62098 Plan or Correction Coglr or Edmonds Completion Date Page 2 of 5 Licensee: Cogit Management USA Inc 07115/2025 As a result of th~ 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. Date I understand 1hat to maintain an Assisted Living Facility license. the facility must be in compliance with all the licensing laws and regulations at all times. ffi~ Administrator (or Representative) WAC 388-78A-2950 Water supply. The assisted living facility must: (6) Provida all sinks in resident rooms, toilet rooms and bathrooms, and bathing fixtures used by residents with hot water between 105 F and 120 Fat all times; and This requirement was not met as evidenced by: Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to ensure the hot water temperatures in the ALF were between ·105 degrees Fahrenheit (F) and 120 degrees F. T11is failure placed 59 of 59 residents at risk for burns and injury. Findings included ... Record review of a Characteristic Roster (undated) showed tt1e ALF provided care and seNir~es for 59 residents. Observation, during the environmental tour with Staff G (Administrator), on 07/08/2025 at 11:17 AM, showed the hot water temperature of the Evergreen Memory Care Unit (MCU) Bathtique sink was 128.1 degrees F. Observation at i 1 :24 AM, showed the hot water temperature of the first floor Bistro sink was 128. 7 degrees F. Observation at 11 :52 AM, showed the hot water temperature of the third floor bathroom sink, located near the Wellness Department, was 122.3 degrees F. Observation of MCU res1demt rooms on 07/09/2025 showed the following hot water temperatures: Room 106 at 11 :45 AM showed a water temperature of 129.6 degrees F. Room 103 at 11 :52 AM showed a water temperatme of 129.7 degrees F. Room 124 at 12:13 PM showed a water temperature of 125.2 deerees F. 7/17/2025 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 62098 Plan of Correction Cogir of Edmonds Completion Date Page 2 of 5 Licensee: Cogir Management USA Inc 07/15/2025 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. 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. Administrator (or Representative) Date WAC 388-78A-2950 Water supply. The assisted living facility must: (6) Provide all sinks in resident rooms, toilet rooms and bathrooms, and bathing fixtures used by residents with hot water between 105 F and 120 Fat all times; and This requirement was not met as evidenced by: Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to ensure the hot water temperatures in the ALF were between 105 degrees Fahrenheit (F) and 120 degrees F. This failure placed 59 of 59 residents at risk for burns and injury. Findings included ... Record review of a Characteristic Roster (undated) showed the ALF provided care and services for 59 residents. Observation, during the environmental tour with Staff G (Administrator), on 07/08/2025 at 11:17 AM, showed the hot water temperature of the Evergreen Memory Care Unit (MCU) Bathtique sink was 128.1 degrees F. Observation at 11 :24 AM, showed the hot water temperature of the first floor Bistro sink was 128.7 degrees F. Observation at 11 :52 AM, showed the hot water temperature of the third floor bathroom sink, located near the Wellness Department, was 122.3 degrees F. Observation of MCU resident rooms on 07/09/2025 showed the following hot water temperatures: Room 106 at 11 :45 AM showed a water temperature of 129.6 degrees F. Room 103 at 11 :52 AM showed a water temperature of 129.7 degrees F. Room 124 at 12:13 PM showed a water temperature of 125.2 degrees F. This document was prepared by Residential Care Services for the Locator website. state of l,lashlngton 7/16 Statement of Daficiericias License#: 2624 Curnpliance Detem,ir,,:ltion # 62098 Pl-an or Correction Coglr or Edmoncls Completion Date Page 3 of 5 Licensee; Cogi1 Management USA Inc 07/15/2025 Room 1-15 at 1: 49 PM showed a water temperature of 128 degrees F. In an interview, on 07/08/2025 at 11:24 AM, Staff G (Executive Director) agreed the water temperatures were too high and stated, "they have been like that the last couple of weeks." Staff G stated tt1e Maintenance Director had been working on coordinating repairs with contractors. Plan/Attestation Stateme~nt rr I hereby certify that I have reviewed this report and have taken or will take active measLtres to correct this deficiency. By taking this action. of G'dmonds is or will be in compliance with this law and I or regulation on (Date) r::. ,~ f <fV J-..S In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) WAC 386-78A·2600 Policies and procedures. (1) The assisted living facility must develop and implement policies and procedures in support of services that are provided and are necessary to: (b) Provide tile necessary care and S8Nices for residents, including those wlth special needs; This roquirement was not met as evidenced by; Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to implement their policies and procedures related to care and safety needs for 2 of 2 residents (Resident 5 and 8) who resided in the Memory Care Unit (MCU) who had bed side rails (BSR). This failure plac.~ed Resident 5 and Resident 8 at risk for Improper use of equipment, injury and entrapment. Findings included, .. Review of the ALF'S policy detail for "Bed Rails and Enablers'', dated 06/01/2024. show~d "Side rail risks and bGnBfits Will bG outlinad to lhe resident and family. Use of rails will be documented in the resident's Negotiated Service Agreement (NSA} along with instructions for monitoring " This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 62098 Plan of Correction Cogir of Edmonds Completion Date Page 3 of 5 Licensee: Cogir Management USA Inc 07/15/2025 Room 115 at 1: 49 PM showed a water temperature of 128 degrees F. In an interview, on 07/08/2025 at 11 :24 AM, Staff G (Executive Director) agreed the water temperatures were too high and stated, "they have been like that the last couple of weeks." Staff G stated the Maintenance Director had been working on coordinating repairs with contractors. 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, Cogir of Edmonds 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-2600 Policies and procedures. (1) The assisted living facility must develop and implement policies and procedures in support of services that are provided and are necessary to: (b) Provide the necessary care and services for residents, including those with special needs; This requirement was not met as evidenced by: Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to implement their policies and procedures related to care and safety needs for 2 of 2 residents (Resident 5 and 8) who resided in the Memory Care Unit (MCU) who had bed side rails (BSR). This failure placed Resident 5 and Resident 8 at risk for improper use of equipment, injury and entrapment. Findings included ... Review of the ALF's policy detail for "Bed Rails and Enablers", dated 06/01/2024, showed "Side rail risks and benefits will be outlined to the resident and family. Use of rails will be documented in the resident's Negotiated Service Agreement (NSA) along with instructions for monitoring." This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 62098 Plan of Correction Cogir of Edmonds Completion Date Page 4 of 5 Licensee: Cogir Management USA Inc 07/15/2025 Resident 5 Review of a Face Sheet showed that the ALF admitted Resident 5 on /2023 with multiple medically disabling conditions including . Observation, on 07/09/2025 at 11 :45 AM, showed BSR installed on both sides of Resident S's bed. Review of Resident S's Service Plan (SP - equivalent to NSA), dated 07/08/2025, gave no documentation to show Resident 5 used BSR. There were no monitoring instructions for staff on the use of BSR. Resident 8 Review of a Face Sheet showed that the ALF admitted Resident 8 on /2024 with multiple medically disabling conditions including and . Observation, on 07/10/2025 at 11 :25 AM, showed BSR attached to both sides of Resident S's bed. Review of Resident S's SP, dated 02/25/2025, gave no documentation to show Resident 8 used BSR. There were no monitoring instructions for staff on the use of BSR. In interview, on 07/09/2025 at 1: 02 PM, Staff H (Health and Wellness Director), reported in order for residents to use BSR, instruction for monitoring and use of bed rails needed to be documented in resident's NSA. In a follow up interview, on 07/09/2025 at 1 :45 PM, Staff H confirmed the ALF did not implement their policy for BSR for Resident 5 and Resident 8 as there was no documentation in their NSAs along with instructions for monitoring. This document was prepared by Residential Care Services for the Locator website. VVU\olU VI rt'UJIJl ll!J\.VII lJ/lli Statement of Delkienc:ies License #: 2624 Compliance Deto,rnir,ation # 62098 Plan or Correction Coglr or Edmoncls completion Date Page 5 of 5 Licensee: Cogir Manage,nent USA Inc 07115/2025 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, C°&J of{dmonds is or will be in compliance with this law and/ or regulation on (Date) I ~S. In addition, I will implement a system to monitor and ensure continued compliance with this requirement. N\, Administrator (or Representative) ~ This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2624 Compliance Determination # 62098 Plan of Correction Cogir of Edmonds Completion Date Page 5 of 5 Licensee: Cogir Management USA Inc 07/15/2025 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, Cogir of Edmonds 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. 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 12/27/2023 Cogir Management USA Inc Cogir of Edmonds 21500 72nd Ave W Edmonds, WA 98026 RE: Cogir of Edmonds # 2624 Dear Administrator: This document references Compliance Determination 33512 (12/13/2023), which included complaint number(s) 105201. The Department completed a complaint investigation of your Assisted Living Facility on 12/13/2023 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-2660 Resident rights. The assisted living facility must: (1) Comply with chapter 70.129 RCW, Long-term care resident rights; The Assisted Living Facility failed to provide a written notification of transfer to a resident. This placed the resident at risk not knowing their rights regarding discharge and transfer. This document was prepared by Residential Care Services for the Locator website. Cogir of Edmonds # 2624 12/13/2023 Page 2 of 2 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 (253)312-1446. 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 Edmonds Provider Type: Assisted Living Facility License/Cert.#: 2624 Compliance Determination #: 33512 Intake ID: 105201 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 12/06/2023 through 12/13/2023 Complainant Contact Date(s): Allegation(s): 1.The Named Resident (NR) was discharged to a local hospital, after the Assisted Living Facility (ALF) refused to allow the resident to return. 2.The ALF stated the NR’s level of care was too high for facility. Investigation Methods: Sample: Total residents: 60 Resident sample size: 3 Closed records sample size: Observations: Residents Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Nursing staff Family members Business office manager Executive Director Record Reviews: Resident Records Investigation Summary: 1. Interview and record review showed the ALF failed to issue a written discharge notice to the NR or the NR's representative. In an interview, a hospital representative stated there was confusing information provided to the ALF about the NR's needs, which were outside of the ALF's scope of practice. In an interview, the ALF's Health and Wellness Director stated that the ALF were prepared to accept the NR to return from the hospital with additional care, but the NR's representative declined the care. In an interview, the NR's representative stated that additional care and services were offered. 2. In an interview, the Health and Wellness Director stated that the ALF had prepared for the NR to return from the hospital with the additional care and services. The NR's representative stated that the NR was moved to a facility to accommodate the resident's needs. Conclusion / Action: This document was prepared by Residential Care Services for the Locator website. 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.