Aegis Living Kirkland.

Residential Care Services Investigation Summary Report Provider/Facility: Aegis Living Kirkland Provider Type: Assisted Living Facility License/Cert.#: 2596 Compliance Determination #: 67906 Intake ID: 199911 Investigator: Karri Hernandez Region/Unit #: RCS Region 2 / Unit D Investigation Date(s): 10/28/2025 through 10/30/2025 Complainant Contact Date(s): Allegation(s): Failed Fire Marshal inspection Investigation Methods: Sample: Total residents: 37 Resident sample size: 0 Closed records sample size: Observations: Residents Interviews: Identified staff Record Reviews: State reporting log Investigation Summary: Facility failed Fire Marshal inspection. Citation issued 10/30/2025 CIID 67906 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.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Aging and Long-Term Support Administration PO Box 45600, Olympia, WA 98504-5600 May 6, 2025 ELECTRONIC-FACSIMILE Administrator Aegis Living Kirkland 13000 Totem Lake Blvd NE Kirkland, WA 98034 Assisted Living Facility License # 2596 Licensee: Totem Lake Blvd Kirkland LLC IMPOSITION OF CIVIL FINES Dear Administrator: On April 24, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a follow-up visit at your facility. This letter constitutes formal notice of civil fines on the license for your assisted living facility, also known as Aegis Living Kirkland, located at 13000 Totem Lake Blvd NE, Kirkland, 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 fines on the license are based on the following violation of the RCW and/or WAC as described in the attached Statement of Deficiencies (SOD) report dated April 24, 2025. Civil Fines WAC 388-78A-2130 (3)(a)(b) Service agreement planning. $400.00 The licensee failed to update the service plans for two residents. This failure placed both residents at risk for unmet care needs and a diminished quality of life. This is an uncorrected deficiency previously cited on February 25, 2025, subsections (3)(a)(b). Administrator Aegis Living Kirkland License # 2596 May 6, 2025 Page 2 WAC 246-215-02310 Hands and arms—When to wash $300.00 (FDA Food Code 2-301.14). WAC 246-215-02305 Hands and arms—Cleaning procedure (FDA Food Code 2-301.12). WAC 246-215-02410 Hair restraints Effectiveness (FDA Food Code 2-402.11). WAC 388-78A-2305 (1) Food sanitation. The licensee failed to follow the required sanitation procedures for one kitchen. This failure placed all 37 residents at risk of consuming contaminated food and contracting food borne illnesses. This is an uncorrected deficiency previously cited on February 25, 2025, Washington Administrative Code (WAC) 388-78A-2305 subsection (1), WAC 246-215-02310 subsection (5), and WAC 246-215-02410 subsection (1). NOTE: These are the violations, which resulted in the fines; see the attached Statement of Deficiencies for any additional violations. 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: Laurie Anderson, Field Manager Region 2, Unit D 20425 72nd Ave S suite 400 Kent, WA 98032-2388 Phone: (253)234-6020 / Fax: (253) 395-5071 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] Administrator Aegis Living Kirkland License # 2596 May 6, 2025 Page 3 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 Formal Administrative Hearing You may contest the civil fines by requesting a formal administrative hearing to challenge the deficiency, which resulted in the civil fines. 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 Administrator Aegis Living Kirkland License # 2596 May 6, 2025 Page 4 Payment: If you do not request a formal administrative hearing, the civil fines are due to the Office of Financial Recovery twenty-eight (28) calendar days after receipt of this letter. Mail a check for $700.00 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. 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. Administrator Aegis Living Kirkland License # 2596 May 6, 2025 Page 5 If you have any questions, please contact Laurie Anderson, Field Manager, at (253) 234-6020. Sincerely, Matt Hauser Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 2, Unit D 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. Residential Care Services Investigation Summary Report Provider/Facility: Aegis Living Kirkland Provider Type: Assisted Living Facility License/Cert.#: 2596 Compliance Determination #: 46916 Intake ID: 145727 Investigator: Karri Hernandez Region/Unit #: RCS Region 2 / Unit D Investigation Date(s): 09/10/2024 through 09/10/2024 Complainant Contact Date(s): Allegation(s): Failed Fire Marshall inspection Investigation Methods: Sample: Total residents: 42 Resident sample size: Closed records sample size: Observations: n/a Interviews: Administrator Record Reviews: Fire Marshal report Investigation Summary: Reviewed intake, reviewed Fire Marshal Documents. Interviewed Administrator of facility. Review of the Washington State Patrol Fire Protection Bureau inspection report, dated 09-03- 2024, showed the facility failed a third Fire Marshal inspection. The document identified multiple fire safety violations. The document showed the facility failed to meet required fire safety regulations. Staff A, Director of Operation, stated that they were aware the facility was out of compliance with the State Fire Marshal regulations. Staff A stated that the facility created a plan to get back into compliance. Staff A stated that the facility received quotes from vendors to come in to fix the deficiencies identified by the fire marshal. Citation issued 09/10/2024. Failed practice identified and Statement of Deficiency issued CID 46916 on 09/12/2024 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.