Weatherly Inn at Lake Meridian, the.

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.

Statement of Deficiencies License #: 1356 Compliance Determination # 26681 Plan of Correction WEATHERLY INN AT LAKE MERIDIAN, THE 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 an unannounced on-site follow-up on 07/14/2023 and 07/14/2023 of: WEATHERLY INN AT LAKE MERIDIAN, THE 15101 SE 272ND ST KENT, WA 98042 This document references the following SOD dated: 07/14/2023 The following sample was selected for review during the unannounced on-site visit: 0 of 0 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Steven Garrett, LTC Licensor Claudia Machado, Community Complaint Investigator Angelica Rios, ALF Licensor From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 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. . Statement of Deficiencies License #: 1356 Compliance Determination # 26681 Plan of Correction WEATHERLY INN AT LAKE MERIDIAN, THE Completion Date Administrator (or Representative) Date WAC 388-78A-2485 Tuberculosis Positive test result. When there is a positive result to tuberculosis skin or blood testing the assisted living facility must: (1) Ensure that the staff person has a chest X-ray within seven days; (2) Ensure each resident or staff person with a positive test result is evaluated for signs and symptoms of tuberculosis; and This requirement was not met as evidenced by: Based on interview and record review the facility failed to ensure 1 of 7 staff, Staff D, Caregiver, had a chest X-ray or was medically evaluated for signs and symptoms after a positive blood test result for tuberculosis (TB). This failure placed all residents at risk of exposure to Tuberculosis, an infectious disease. Findings included… Record review of the Department's, "Secure Tracking and Reporting Systems" (STARS) showed the Assisted Living Facility (ALF) received the first citation for this regulation on 03/03/2023 for Staff C. The ALF signed an attestation statement that stated the facility would have a system in place and the deficiency corrected by 04/24/2023. Record review of the Department's, "Secure Tracking and Reporting Systems" (STARS) showed the Assisted Living Facility (ALF) received a second citation for this regulation on 05/18/2023 for Staff C. The ALF signed an attestation statement that stated the facility would have a system in place and the deficiency corrected by 06/09/2023. Review of the facility's personnel staff records showed that the facility hired Staff D on 01/30/2023. Review of Staff D's personnel records showed documentation that Staff D received the first step of the two-step tuberculosis screening test on 02/08/2023. The first step test results were read on 02/11/2023 and showed a positive reaction. Further review showed Staff D completed a blood test on 05/09/2023 with a positive finding for TB. There was no documentation that showed the facility requested Staff D obtain a chest X-ray, as required. There was no documentation that showed Staff D was medically evaluated for signs and symptoms of TB. Review of the facilities staff schedule showed that Staff D worked in the facility since their hire date. Staff D was allowed direct access to residents while they worked. . Statement of Deficiencies License #: 1356 Compliance Determination # 26681 Plan of Correction WEATHERLY INN AT LAKE MERIDIAN, THE Completion Date During an interview on 07/14/2023 at 11:45 AM, Staff B, Director of Nursing Services, stated that Staff D was instructed to obtain a chest x-ray. Staff B stated that Staff D reported in a phone interview on 07/14/2023 that they had not completed the chest X-ray as directed. Staff B also confirmed the facility had not received documentation that Staff D completed a medical evaluation for the signs and symptoms of tuberculosis. This is a recurring deficiency cited on 05/18/2023 and 03/03/2023 and an uncorrected deficiency previously cited on 05/18/2023 and 03/03/2023. 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, WEATHERLY INN AT LAKE MERIDIAN, THE 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 . . 06.01.2023 09:03:32 State of Mashington STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98012 sfafenie,1t·oroe11dendes··· ·· ·ticense #: 13se con,pifai,ce Determination# 23e91· Plan qf Correction WEATHERLY INN AT LAKE. MERIDIAN, THE Completion Date Page 1 of6 Licensee: VVEA THERL Y INN-KENT LLC 05/18/2023 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 an unannounced on~site follow-up on 05/08j2023 and 05/08/2023 of: WEATHERLY INN AT LAKE MERIDIAN, THE 15101 SE 272ND.ST KENT, WA 98042 This document references the following SOD oated: 05/18/2023 The following sample was selected for review during the unannounced on~site visit O of 45 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Steven Garrett, LT C Licensor Claudia Machado, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 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. 06/01/2023 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. . 06.01.2023 09:03:32 State of l-lashington 4/10 Statement of Deficiencies License#: 1356 Compliance Determination# 23691 Plan of Correction WEATHERLY INN AT LAKE MERIDIAN, THE Completion Date Page 2 of6 Licensee: WEATHERLY INN-KENT LLC 05/18/2023 f;/r/~ Date WAC 388-78A•2485 Tuberculosis Positive test result. When there is a positive result to tuberculosis skin or blood testing the assisted living facility must: ( 1) Ensure that the staff person has a chest X-ray within seven days; (2) Ensure each resident or staff person with a positive test result is evaluated for signs and symptoms of tuberculosis; and This requirement was not met as evidenced by: Based on interview and record review the facility failed to ensure 1o f 7 staff, Staff C, Caregiver, had a chest X-ray after a positive test result to a tubercuiosis (TB) skin test. This failure placed all residents at risk of exposure to Tuberc.ulosis. an infectious disease. Findings included ... Record review of the Department's, "Secure Tracking and Reporting Systems" (STARS) showed the Assisted Living Facility (ALF) received a citation for this regulation on 03/28/2023 for Staff C. The ALF signed an attestation statement that stated the facility would have a system in place and the deficiency corrected by 04/24/2023. Review of Staff C's facility personnel records showed thatthe facility hired Staff Con 02/09/2023. The facility initiated the first step of the two-step TB screening on 02/03/2023. Tt,e te6t results were read on 02/05/2023 and showed a positive reaction. There was no documentation that showed the facility requested Staff C obtain a chest X-ray, as required. Additionally, there was no docutnentation that showed Staff C was evaluated for signs and symptoms oftubercolosis During an interview on 05/08/2023 at 11 :45 AM, Staff B, Director of Nursing Services, stated that Staff C was not sent to have a chest X-ray completed after Staff C's initial TB skin test showed a positive result. Staff B also confirmed the facility had not received documentation that Staff C completed a m~dical evaluation for the signs and symptoms of tuberculosis. Staff B provided no explanation for the failure to correct the lack of follow through with TB testing for Staff C after the initial licensing inspection found facility failed practice. This is an uncorrected deficiency previously cited on 03/03/2023. . 06.01.