Aegis Senior Inn of Kent.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98032 Statement of Deficiencies License #: 1944 Compliance Determination # 57618 Plan of Correction AEGIS SENIOR INN OF KENT Completion Date Page 1 of 3 Licensee: Aegis Senior Communities LLC 04/17/2025 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 04/09/2025 and 04/11/2025 of: AEGIS SENIOR INN OF KENT 10421 SE 248th St Kent, WA 98030 The following sample was selected for review during the unannounced on-site visit: 7 of 33 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Claudia Allis, ALF Licensor Steven Garrett, LTC Licensor Jane Hermano, NCI From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit D 20425 72nd Avenue S, Suite 400 Kent, WA 98032 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 1944 Compliance Determination # 57618 Plan of Correction AEGIS SENIOR INN OF KENT Completion Date Page 2 of 3 Licensee: Aegis Senior Communities LLC 04/17/2025 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 388-112A-0105 Who is required to obtain home care aide certification and by when? Unless exempt under WAC 246-980-070 , the following individuals must be certified by the department of health as a home care aide within the required time frames: (1) All long-term care workers, within two hundred days of the date of hire; WAC 388-78A-2474 Training and home care aide certification requirements. (4) The assisted living facility must ensure all persons listed in subsection (2) of this section, obtain the home-care aide certification. This requirement was not met as evidenced by: Based on interviews and review records, the facility failed to ensure 1 of 6 staff (Staff E), completed all the training required to perform their job duties and responsibilities. This failure placed all 33 residents at risk of unmet care needs from staff with incomplete training. Findings included… Review of the facility’s personnel records showed the facility hired Staff E, Care Manager, on 01/10/2023. The records showed that on 01/06/2022, Staff E completed the basic training requirements for long-term care workers. Review of the personnel records showed documentation that Staff E’s current credential as a Nursing Assistant Registered expired on 08/21/2025. The records showed no documentation that Staff E completed the Home Care Aide certification (HCA). During an interview on 04/11/2025 at 2:10 PM, Staff A, General Manager, stated that they were unaware that Staff E worked at the facility for 823 days without completing This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 1944 Compliance Determination # 57618 Plan of Correction AEGIS SENIOR INN OF KENT Completion Date Page 3 of 3 Licensee: Aegis Senior Communities LLC 04/17/2025 the HCA certification. 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, AEGIS SENIOR INN OF KENT 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.

Residential Care Services Investigation Summary Report Provider/Facility: AEGIS SENIOR INN OF Provider Type: Assisted Living Facility KENT License/Cert.#: 1944 Intake ID: 138217 Compliance Determination #: 44044 Region/Unit #: RCS Region 2 / Unit D Investigator: Harrison Udoye Investigation Date(s): 07/11/2024 through 08/12/2024 Complainant Contact Date(s): Allegation(s): Alleged safety concerns Investigation Methods: Sample: Total residents: 38 Resident sample size: 1 Closed records sample size: 1 Observations: Residents Activities Resident care equipment Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Identified staff Nursing staff Residents Human resources Therapy staff Staff development coordinator Record Reviews: Medical records Hospital records Incident investigation Facility policies Personnel files Staff training records Investigation Summary: Report of alleged neglect in the Assisted Living Facility (ALF). Interview and record review showed that on 07/10/2024 at about 2:00 PM, Named Resident and spouse were seated out on the covered area of the patio, directly outside of the facility day room. Per facility report Named Resident and spouse were asked to come inside due to high the temperature. Spouse agreed, Named Resident insisted on staying outdoors. Facility staff stated that Named Resident's upper torso This document was prepared by Residential Care Services for the Locator website. was under the shade and their feet exposed to the sun. Sun exposure caused blisters to Named Resident's feet. Facility staff immediately applied first aid, notification of Resident representative and other appropriate agencies. Failed practice identified. Facility failed to implement hourly safety checks on the Named Resident as stated in the individualized care plan and service agreement. Citation 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.