Channel Point Village.

Statement of Deficiencies License #: 2621 Compliance Determination # 70245 Plan of Correction Channel Point Village 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 completed data collection for the unannounced on-site full inspection on 12/16/2025 and 12/19/2025 of: Channel Point Village 907 K St Hoquiam, WA 98550 The following sample was selected for review during the unannounced on-site visit: 9 of 76 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Anissa Bearden, Licensor Celeste Vashey, ALF LTC Licensor From: DSHS, Aging and Long-Term Support Administration 800 NE 136th Ave Ste 200 Vancouver, WA 98684 . Statement of Deficiencies License #: 2621 Compliance Determination # 70245 Plan of Correction Channel Point Village 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. 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 F at all times; and This requirement was not met as evidenced by: Based on observation, interview and record review, the facility failed to ensure the facility’s hot water temperature did not go above 120 degrees Fahrenheit (F) in 5 of 5 areas (Memory Care Unit dining room, Resident 1, 2, and 11’s sink and Memory Care Unit public shower/bathroom). This failure placed all memory care residents and staff at risk for potential skin burns, discomfort, and decreased quality of life. Findings included… Record review of the facility’s policy titled, “Resident Hot Water Temperature Log”, undated, documented the regulation was for nursing homes and the facility must ensure the hot water system maintained hot water temperatures at 110 degrees F, plus or minus ten degrees F at fixtures used by residents and staff. The hot water temperature should not exceed 120 degrees F. Eight apartments per floor per month were to be checked. On 12/16/2025 at 10:47 AM, in the memory care unit’s dining room public sink, the hot water temperature was 120.7 degrees F that was hot to touch. On 12/16/2025 at 11:31 AM, in Resident 1 (R1)’s apartment bathroom, the hot water temperature was 120.7 degrees F. . Statement of Deficiencies License #: 2621 Compliance Determination # 70245 Plan of Correction Channel Point Village Completion Date On 12/16/2025 at 11:33 AM, Resident 2 (R2)’s hot water temperature in their bathroom was 120.6 degrees F. When the thermometer was placed inside of the water, steam had been observed to come off the device. Collateral Contact 1, R2’s Power of Attorney, stated “the water is hotter than hot.” On 12/16/2025 at 11:31 AM, in Resident 11 (R11)’s apartment bathroom, the hot water temperature was 120.5 degrees F. While the hot water was running there was steam observed to rise and it was hot to touch. On 12/16/2025 at 11:38 AM, in the memory care unit’s television room public bathroom and shower room sink, the hot water temperature was 121.0 degrees F. On 12/16/2025 at 12:00 PM, Staff A, Executive Director, was notified that five areas in the memory care unit were with hot water temperatures over 120 degrees F and requested a safety plan to protect the memory care residents from injuries. Staff A stated they would notify the home office to get guidance as the maintenance director was out of the facility that day. In an interview on 12/16/2025 at 12:36 PM, Staff A stated Staff N, Regional Maintenance, would turn the hot water tanks down in the memory care unit. On 12/16/2025 at 2:02 PM, in the memory care unit’s dining room sink, the hot water temperature was 122.6 degrees F. In an interview on 12/16/2025 at 2:16 PM, Staff A stated Staff G would check the hot water temperatures in the memory care unit tomorrow morning, 12/17/2025, and that Staff N had just turned the hot water temperatures down five minutes prior. In an interview on 12/16/2025 at 2:22 PM, Staff J, Assistant Executive Director, was requested how the facility was ensuring memory care residents were out of danger of being burned until the hot water temperatures were checked 12/17/2025 in the morning and stated they would have to talk with Staff A and get back with a plan. On 12/17/2025 at 11:34 AM, Staff G stated they had worked for the facility for a few months. Staff G stated that 12/17/2025 was the first time they checked hot water temperatures for the facility since they were hired. Staff G did not know the accurate water temperature range that was required for the facility. Staff G stated they could not provide any water temperature logs to review since they started employment for the facility. On 12/18/2025 at 1:09 PM, Staff A stated when they were first hired, they provided Staff G the facility hot water temperature policy and water temperature log. Staff H, Vice President of Operations, stated Staff G had been aware it was their responsibility to . Statement of Deficiencies License #: 2621 Compliance Determination # 70245 Plan of Correction Channel Point Village Completion Date check hot water temperatures within the facility. 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, Channel Point Village 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-2070 Timing of preadmission assessment. (1) Unless there is an emergency, the assisted living facility must complete the preadmission assessment of the prospective resident before each prospective resident moves into the assisted living facility. (2) The assisted living facility must ensure the preadmission assessment is completed within five calendar days of the resident moving into the assisted living facility when the resident moves in under emergency conditions. (3) For the purposes of this section, "emergency" means any circumstances when the prospective resident would otherwise need to remain in an unsafe setting or be without adequate and safe housing. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to complete and document a preadmission assessment for 1 of 5 sampled residents (Resident 3 [R3]). This failure placed R3 at risk for improper placement in the facility and unmet care needs by untrained staff. Findings included… Record review of the facility’s policy titled, “Assessment/NSA[negotiated service agreement]” dated 02/01/2018, documented the community would encourage resident wellness, health promotion and disease prevention through an initial admission assessment and regular wellness visits by the director of nursing or designee. A completed resident assessment was to be obtained up to 14 days prior to move-in or per state regulation. . Statement of Deficiencies License #: 2621 Compliance Determination # 70245 Plan of Correction Channel Point Village Completion Date Record review of the facility documented titled, “Face Sheet”, undated, documented R3’s date of current readmission was on /2025. On 12/16/2025 at 1:09 PM, all R3’s assessments including their pre-admission were requested to review. On 12/17/2025 at 11:52 AM, Staff J, Assistant Executive Director, stated R3 was a readmission to the facility. Staff J stated R3 moved out of the facility in 2025 with their son and then moved back into the facility on /2025. Staff J confirmed that R3 was taken off the facility’s census as a resident when they moved out in . Staff A, Executive Director, stated there were no changes to the care and services R3 required and prior assessment was reinstated. On 12/18/2025 at 11:38 AM, R3’s pre-admission assessment was requested to review. On 12/19/2025 at 3:07 PM, Staff A stated the director of nursing was responsible for completing all assessments for newly admitted residents that included the pre-admission assessments. As of 12/23/2025 at 5:30 PM, R3’s pre-admission assessment was not provided.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . .

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . . .