Scriber Gardens Llc.

SCRIBER GARDENS LLC # 2203 04/18/2025 Page 2 of 2 The Assisted Living Facility (ALF) failed to include in their assessment that the NR was able to leave the ALF on their own unsupervised. Review of record of the NR and newly admitted residents assessments showed the ALF corrected the failure and captured residents ability to leave the facility unsupervised. A consultation was issued under WAC 388- 78A-2090 (6) (d) Full assessment topics. 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: Email: RCSIDR@dshs.wa.gov; or Fax: (360) 725-3225 If You Have Any Questions: • Please contact me at (253)281-1245. Sincerely, Anthony Devito, Field Services Administrator Region 2, Unit Z Residential Care Services This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: SCRIBER GARDENS LLC Provider Type: Assisted Living Facility License/Cert.#: 2203 Intake ID: 173257 Compliance Determination #: 57347 Region/Unit #: RCS Region 2 / Unit A Investigator: Wesler Dumecquias Investigation Date(s): 04/02/2025 through 04/18/2025 Complainant Contact Date(s): Allegation(s): The Named Resident (NR) left the Assisted Living Facility (ALF) and went missing. Investigation Methods: Sample: Total residents: 37 Resident sample size: 3 Closed records sample size: 0 Observations: Identified resident Residents Activities Resident rooms Interviews: Identified resident Nursing staff Residents Family members Record Reviews: Facility policies Incident investigation Care plan Assessments PCP Admission order Progress Notes MAR Investigation Summary: The Named Resident (NR) left the ALF and was not able to return on their own. The NR was brought back to the ALF by the police the next day early in the morning after they were missing. The Assisted Living Facility (ALF) failed to include in their assessment that the NR was able to leave the ALF on their own unsupervised. The ALF were working with the NR's contact for guardianship. The NR keeps an air tag in their wallet as a precaution. The ALF updated the care plan to meet the NR need. Review of record from a newly admitted residents' assessment showed the ALF corrected the failure. A consultation was issued under WAC 388- 78A-2090 (6) (d) Full assessment topics. This document was prepared by Residential Care Services for the Locator website. 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. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98032 SCRIBER GARDENS LLC SCRIBER GARDENS LLC 6024 200TH ST SW LYNNWOOD, WA 98036 RE: SCRIBER GARDENS LLC License# 2203 Dear Administrator: This letter addresses Compliance Determination(s) 70545 (Completion Date 12/23/2025) and 67231 (Completion Date 10/30/2025). The Department completed a follow-up inspection of your Assisted Living Facility on 12/23/2025 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-2320-1-a, WAC 388-78A-2320-2-a, WAC 388-78A-2320-2-b, WAC 388-78A- 2320-1-b, WAC 388-78A-2466-1-a, WAC 388-78A-2466-1-b, WAC 388-78A-2466-1, WAC 388- 78A-2480-1, WAC 388-78A-2468-1, WAC 388-78A-2150-1, WAC 388-78A-2150-2, WAC 388- 78A-2240, WAC 388-78A-2160, WAC 388-78A-2210-1-b, WAC 388-78A-2210-2-b, WAC 388- 78A-2210-2-a The Department staff who did the on-site verification: Jodi Condyles, Nursing Consultant Institutional Steven Kindle, Nursing Consultant Institutional If you have any questions, please contact me at (206)305-3489. Sincerely, James Sherman, Field Manager Region 2, Unit D Residential Care Services 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 #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 1 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 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 10/15/2025 and 10/20/2025 of: SCRIBER GARDENS LLC 6024 200TH ST SW LYNNWOOD, WA 98036 The following sample was selected for review during the unannounced on-site visit: 7 of 41 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Jodi Condyles, Nursing Consultant Institutional Steven Kindle, Nursing Consultant Institutional 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. This document was prepared by Residential Care Services for the Locator website. N0V/0 02 RI 03:50 PM SCRIBER GARDENS FAX No, P. 002 t 1.Hb,tHto tb: 11:ob ~tate ot wasnm9ton Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 2 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 As a resltlt of the on-site visit(s), the department found that yolt are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report ~s~ 11-05-2025 t/ 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, WAC 388-78A-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services lo any resident. either directly or indirectly, the assisted living facility must: (a) Develop and implement systems that support and promote the safe practice ot nursing for each resident; and (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. (2) The assisted living facility providing nursing services, either directly or indirectly, must ensure that the nursing services systen1s includ.e: (a) Nursing services supervision; (b) Nurse delegation, if provided; This requirament was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to develop and implement a safe intermittent nursing service sy.stem related to nurse delegation services for 4 of 7 residents (Resident 1, Resident 2, Resident 4, and Resident 6). This failure placed residents at risk for medication-related complications and compromised health status. Findings inClltded,'' Review of Washington Administrative Code (WAC) 246-840-930 The Nurse Delegation Program, under Washington State law, allows nltrsing assistants working in certain settings to perform certain tasks• such as administration of prescription medications including inslllin injections - normally pertormed only by licensed nurses. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 2 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 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-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services to any resident, either directly or indirectly, the assisted living facility must: (a) Develop and implement systems that support and promote the safe practice of nursing for each resident; and (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. (2) The assisted living facility providing nursing services, either directly or indirectly, must ensure that the nursing services systems include: (a) Nursing services supervision; (b) Nurse delegation, if provided; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to develop and implement a safe intermittent nursing service system related to nurse delegation services for 4 of 7 residents (Resident 1, Resident 2, Resident 4, and Resident 6). This failure placed residents at risk for medication-related complications and compromised health status. Findings included… Review of Washington Administrative Code (WAC) 246-840-930 The Nurse Delegation Program, under Washington State law, allows nursing assistants working in certain settings to perform certain tasks - such as administration of prescription medications including insulin injections - normally performed only by licensed nurses. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 3 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 If the registered nurse delegator determines delegation is appropriate, the nurse discusses the delegation process with the patient or authorized representative, including the level of training of the nursing assistant or home care aide delivering care, obtains written consent. The patient, or authorized representative, must give written consent to the delegation process under chapter 7.70 RCW. Review of the ALF’s undated Disclosure of Services showed the facility provided intermittent nursing services. Review of the ALF’s policy titled, “Nurse Delegation Services”, dated 09/28/2022, showed the delegation process was to be done in accordance with the State requirements. The policy showed that consent for registered nurse delegation will be obtained from the resident/family upon move in or at the time delegation is needed and will be maintained in the resident’s chart. The Wellness Director will ensure that all nursing assistants that will be delegated have appropriate certification/registration and have completed appropriate training and are willing and able to perform delegated tasks. Review of the ALF’s undated Resident Characteristic Roster provided on 10/15/2025 showed twenty-six residents received nurse delegation. Review of Collateral Contact 1’s (CC1), Registered Nurse (RN)/Nurse Delegator (ND), Nurse Delegator Resident Roster on 10/20/2025 showed the ALF had seventeen residents receiving nurse delegation services. Review of an updated ALF’s Resident Characteristic Roster provided on 10/20/2025 showed nineteen residents receiving nurse delegation. Review of the Delegation Binder on 10/16/2025 showed 5 resident consent forms had been signed by the resident/resident representative. Resident 1 Review of a face sheet, dated 06/18/2025, showed Resident 1 admitted to the ALF on /2025 with multiple diagnoses including and . Review of Resident 1’s memory care assessment, dated /2025, showed Resident 1 required medication administration for all medications. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 4 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Review of the ALF’s undated Resident Characteristic Roster provided on 10/15/2025 showed Resident 1 received nurse delegation services. Review of the facility nurse delegation binder on 10/16/2025 showed no signed consent, no nurse delegation visits, and no nurse delegation instructions for Resident 1. Review of the updated Resident Characteristic Roster provided on 10/20/2025 showed Resident 1 had not received nurse delegation services. Review of Resident 1’s medication administration records (MARs) dated August 2025, September 2025 and October 2025 showed all medications had been given by multiple ALF staff including oral, topical and PRN (as needed) medications. Review of the Nurse Delegator’s Resident Roster on 10/20/2025 at 9:45 AM, showed Resident 1’s medications were not delegated to staff by the nurse delegator. On 10/20/2025 at 10:28 AM, Staff I, Memory Care Director, stated that all residents in the memory care unit required medication administration due to their diagnosis so they were delegated. On 10/20/2025 at 2:33 PM, CC1, RN/ND, stated that if residents were assessed as needing medication administration, they were required to be nurse delegated. Resident 2 Review of a face sheet, dated 06/18/2025, showed Resident 2 admitted to the ALF on /2025 with diagnoses to include . Review of Resident 2’s Self Medication Assessment, dated 04/17/2025, showed the resident had been assessed that they had demonstrated ability to safely self-administer medications without assistance. Review of Resident 2’s assessment, dated 04/16/2025, showed for medication assistance level required that the resident required their medication to be administered. Review of an undated Resident Characteristic Roster, provided on 10/15/2025, showed Resident 2 did not receive nurse delegation services.. Review of the facility nurse delegation binder on 10/16/2025 showed no nurse delegation consent, no nurse delegation visits, and no nurse delegation tasks or instructions for staff. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 5 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 On 10/17/2025 at 8:10 AM, Staff J, RN, stated that ALF staff were administering Resident 2’s medications. On 10/17/2025 at 12:12 PM, Staff H, Licensed Practical Nurse (LPN)/Wellness Director (WD), stated that Resident 2 did not do good with their oral medication and that the resident only self- administered their inhalers. Staff H stated that the Self Medication Assessment, dated 04/17/2025, that indicated the resident could safely self-administer their own medications was only for their inhalers. Staff H stated that they administered Resident 2 their oral medications. Resident 4 Review of a face sheet, dated 10/15/2025, showed Resident 4 admitted to the ALF on /2025 with diagnoses to include , and . Review of Resident 4’s assessment, dated /2025, showed that the assessor documented that the medication assistance level required was administration by staff. Review of Resident 4’s care plan, dated 07/04/2025, showed that the resident needed medication assistance. Review of a Nurse Delegation: Nursing Visit, dated 07/14/2025, showed that the resident had nurse delegated tasks for insulin administration, blood glucose monitoring, and application of transdermal patches. The review did not show Staff D, Caregiver, had been delegated to provide nurse delegated tasks to Resident 4. Review of Resident 4’s August 2025, September 2025 and October 2025 MARs showed documentation that Staff D had administered multiple doses of Humalog insulin (a type of injectable insulin) and monitored blood sugars for Resident 4. On 10/17/2025 at 12:12 PM, Staff H, stated that Resident 4 administered their own insulin and did their own blood sugar monitoring. Staff H stated that they could not explain why Resident 4 was nurse delegated for insulin administration and blood sugars. Staff H stated that they had done the assessment dated 07/04/2025 when the medication assistance level was assessed that the resident needed their medications administered. On 10/17/2025 at 2:49 PM, Resident 4 stated that the nurse did their blood sugars and then the nurse gave them the insulin, and the resident self-administered (injected) it. Resident 6 Review of a face sheet, dated 10/15/2025, showed Resident 6 admitted to the ALF on This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 6 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 /2025 with diagnoses to include and . Review of Resident 6’s care plan, dated 05/10/2025, showed that for additional nursing services, the resident was to receive medication administration. Review of Resident 6’s assessment, dated 04/29/2025, showed that the resident was legally blind in both eyes. The assessment also indicated that for medication assistance level required, the resident was assessed as requiring medications be administered. Review of an undated Resident Characteristic Roster, provided on 10/15/2025, showed Resident 6 had nurse delegated tasks. Review of the facility nurse delegation binder on 10/16/2025 showed for Resident 6 there was no nurse delegation consent, no nurse delegation visits, and no nurse delegation tasks or instructions for any staff. Review of Resident 6’s September 2025 MARs showed on 09/20/2025 at 8:00 AM, Staff D, administered the resident an insulin injection of Humalog insulin. On 10/16/2025 at 1:16 PM, Staff A, Executive Director, stated that Staff D, Caregiver, was not nurse delegated. On 10/17/2025 at 10:41 AM, CC1, RN/ND, stated that they had not been notified Resident 6 needed nurse delegation. CC1 stated that they had been told that staff dialed up the resident’s insulin dose and handed it to the resident who then injected it. On 10/17/2025 at 12:38 PM, Staff H, stated that Resident 6 needed all their medications administered. On 10/17/2025 at 3:07 PM, Resident 6 stated that they were not diabetic and they didn’t take insulin. The resident stated that staff were checking their blood sugar, and they had asked them why, when they were not diabetic. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. N0V/0 02 RI 03:51 PM SCRIBER GARDENS FAX No, P. 007 11 ,Ub,miu lb: I l!Ub ~tate Ot W8Shl09tDTI Statement of Deficiencies License #: 2203 Compliance Determination# 67231 Plan of Correction SCRIBER GARDENS LLC Completion Dam Paga 7 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 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, SCRIBER GA~CJENS LLC is or will be in compliance with this law and I or regulation on (Date) I 8-~ J..!> - . In addition, I will implement a system to monitor and ensure continued compliance wi.th this requirement. I \ -,~ ;;5 Administrator (or Representative) Date WAC 388-78A-2466 Background checks Washington state name and date of birth background check Valid for two years National fingerprint background check Valid indefinitely. (1) A Washington state name and date of birth background check is v.alid for two years from the initial date it is conducted. The assisted living facility must ensure; {a) A new DSHS background authorizati.on form is submitted to the department's background check central unit every two years for all administrators, caregivers, staff persons, volunteers and students; and (b) There is. a valid Washington state name !l,nd date of birth background check for all administrators, ca_regivers, staff persons, volunteers end students. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 2 of 2. staff (Staff E and Staff F) had a. valid Washington State name and date of birth background check completed every two years. This failure resulted in Staff E and Staff F not having cleared background .checks and placed residents at risk of being care.d for by a staff person with a potentially disqualifying background. • Findings included .. Review of the ALF's employee files showed the following: Staff Caregiver, was hired on 04/12/2023. Staff E had an interim fingerprint background check dated 04/10/2023, that was valid until 04/10/2025. Review of a Washington State name and date of birth background check showed it was not completed until 05/01/2025, which was 21 days late Staff F, Caregiver, was hired on 12/23/2022. Staff F had an interim fingerprint background check dated 12/14/2022 lhat was valid until 12114/2024. Review of a Washington State name and date of birth background check showed it was not completed until 01/09/2025, which was 26 days late. On 10/16/2025 at 1: 20 PM, Staff G, Business Office Manager, stated that Staff E and Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 7 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 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, SCRIBER GARDENS LLC 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-2466 Background checks Washington state name and date of birth background check Valid for two years National fingerprint background check Valid indefinitely. (1) A Washington state name and date of birth background check is valid for two years from the initial date it is conducted. The assisted living facility must ensure: (a) A new DSHS background authorization form is submitted to the department's background check central unit every two years for all administrators, caregivers, staff persons, volunteers and students; and (b) There is a valid Washington state name and date of birth background check for all administrators, caregivers, staff persons, volunteers and students. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 2 of 2 staff (Staff E and Staff F) had a valid Washington State name and date of birth background check completed every two years. This failure resulted in Staff E and Staff F not having cleared background checks and placed residents at risk of being cared for by a staff person with a potentially disqualifying background. Findings included… Review of the ALF’s employee files showed the following: Staff E, Caregiver, was hired on 04/12/2023. Staff E had an interim fingerprint background check dated 04/10/2023, that was valid until 04/10/2025. Review of a Washington State name and date of birth background check showed it was not completed until 05/01/2025, which was 21 days late. Staff F, Caregiver, was hired on 12/23/2022. Staff F had an interim fingerprint background check dated 12/14/2022 that was valid until 12/14/2024. Review of a Washington State name and date of birth background check showed it was not completed until 01/09/2025, which was 26 days late. On 10/16/2025 at 1:20 PM, Staff G, Business Office Manager, stated that Staff E and This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. !JOV/0 02 RI 03: 5! PM SCRIBER GARDENS FAX No. P. 008 11 ,DD,l.UW IOl 11 HJI) 3tii:ltil:3 Ut WJ~n I llYtUII Statement of Deficiencies License #: 2203 Compliance Determination# 67231 Ptan of Correction SCR.IBE.R GARDENS LLC Completion Date Page 8 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Staff F did not respond timely to their requests to do another background check. 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, SCRIBER AR ENS_LLC is or will be in compliance with this law and / or regulation on (Date) '2,.- / b :i- ~ . In addition, I will implement a system to monitor and ens·ure continued compliance wllh this requirament. Date WAC 388-78A-2480 Tube.rculosls Teslhig Required. (1) The assisted living facility must develop and Implement a system to ensure each staff person is screened for tuberculosis within three days of employment This requirement was not met as evidenced by: Based on inteliliew and record review, the Assisted Living Facility (ALF) failed to ensure 2 of 4 staff (Staff 8 and Staff D) completed tuberculosis (TB) testing within three days of hire. This failure placed n:1sidents at risk of exposure to a communicable disease. Findings included ... Review of the ALF's employee file$ $hawed the following: Staff B, Caregiver, was hired on 02/21/2025. There was no documentation· in Staff B's file. that they had TB testing within three days of hire. Staff D, Caregiver, was hired on 06/13/2025. The initial TB test was completed on 08/01/2025, 49 days late. Review of the ALF's staff schedules for October 2025 showed Staff B was scheduled to work nine $hifts from 10/01/2025 -10/14/2025, On 10/16/2025 11t 1 32 PM, Staff G, Business Office Manager, stated !hat they thought Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 8 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Staff F did not respond timely to their requests to do another background check. 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, SCRIBER GARDENS LLC 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-2480 Tuberculosis Testing Required. (1) The assisted living facility must develop and implement a system to ensure each staff person is screened for tuberculosis within three days of employment. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 2 of 4 staff (Staff B and Staff D) completed tuberculosis (TB) testing within three days of hire. This failure placed residents at risk of exposure to a communicable disease. Findings included… Review of the ALF’s employee files showed the following: Staff B, Caregiver, was hired on 02/21/2025. There was no documentation in Staff B’s file that they had TB testing within three days of hire. Staff D, Caregiver, was hired on 06/13/2025. The initial TB test was completed on 08/01/2025, 49 days late. Review of the ALF’s staff schedules for October 2025 showed Staff B was scheduled to work nine shifts from 10/01/2025 – 10/14/2025. On 10/16/2025 at 1:32 PM, Staff G, Business Office Manager, stated that they thought This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. N0V/0 02 RI 03:51 PM SCRIBER GARDENS FAX No, P. 009 11 .~b.l0ln lb:11:nb ~tote ot wosn,ngton Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 9 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Staff B's TB test from their previO'Us employment with tl,e ALF was adequate for TB testing and was unsure why Staff D did not have their initial TB test at time of hire. • Plan/Attestation Statement I hereby certify that I h.ave reviewed this re.port and have taken or will take active measures to correct this deficiency. By taking this-action, SCRIBER qARDENS LLC is or will be in compliance with this law and I or regulation on (Date) I2 ./_I ?:>j 2,)~ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Date WAC 388-78A-2468 Background checks Employment Conditional hire Pending results of Washington state name and date of birth background check. The assisted living facility may conditionally hire an administrator, caregiver, or staff person directly or by contract, pending the result of the Washington state name and dat8 of birth background check, provid8d that the as.sisted living facility: (1) Submits the background authorization form for the person to the department n<'l later than one business day after he or she starts working; This requirement was not met as evidenced by; Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 1 of 6 staff (Staff B) had a Washington State name and date of birth background check that was submitted within one business day after their date of hire. This failure placed residents at risk of being cared for by a staff person with a potentially c;iisqualifying background Findings Included ... Review of the ALF's employee files showed the following: Staff 8, Caregiver, was hired on 02/2112025. Staff B did not have a Washington State name and date of birth background check available tor review. Staff B was employed 237 calendar days without a background check subm'itted. On 10/16/2025 at 1: 20 PM, Staff G, Business Office Manager, stated that.Staff B had Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 9 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Staff B’s TB test from their previous employment with the ALF was adequate for TB testing and was unsure why Staff D did not have their initial TB test at time of hire. 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, SCRIBER GARDENS LLC 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-2468 Background checks Employment Conditional hire Pending results of Washington state name and date of birth background check. The assisted living facility may conditionally hire an administrator, caregiver, or staff person directly or by contract, pending the result of the Washington state name and date of birth background check, provided that the assisted living facility: (1) Submits the background authorization form for the person to the department no later than one business day after he or she starts working; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 1 of 6 staff (Staff B) had a Washington State name and date of birth background check that was submitted within one business day after their date of hire. This failure placed residents at risk of being cared for by a staff person with a potentially disqualifying background. Findings included… Review of the ALF’s employee files showed the following: Staff B, Caregiver, was hired on 02/21/2025. Staff B did not have a Washington State name and date of birth background check available for review. Staff B was employed 237 calendar days without a background check submitted. On 10/16/2025 at 1:20 PM, Staff G, Business Office Manager, stated that Staff B had This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. NOV/0 02 RI 03:52 PM SCRIBER GARDENS FAX No, P. 0l 0 11 .~b.l~ln lb: 11:nu ~tate ot wasnington Statement of Deficiencies License #: 2203· Compliance Determination# 67231 •• Pl11n of Correction SCRIBER GARDENS LLC Completion Date Page10 of18 Licensee: SCRIBER GARDENS LLC 10/30/2025 previously worked for the ALF, and they did not do a new background check when they were re hired. Plan/Attestation StatemGnt I herepy certify that I have reviewed this report and have tiaken or will take active measures to correct this deficiency, By taking this a.ction, SCRIBER AR ENS LLC is or will be in compliance with this law and/ or regulation on (Date) I' L ~ :l.S"' In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Date. WAC 388-78A-2150 Signing negotiated ser:vice agreement. The assisted living facility must .ensure that the negotiated service agreement is agreed to and signed at least annually by: (1) The resident. or the resident's representative if the resident has pne and is unable IP sign or chooses not to sign: (2) A representative of the assisted living facility duly authorized by the assisted living facility to sign on its behalf; and This requirement was not met a.s evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) fall.ed to ensure the Negotiated Service Agreement (NSA) was agreed to and l!igned at least annually by 2 of 7 residents (Resident 3 and Resident 7) or their representatives, and by a representative of the ALF. This failure placed the residents at risk for unmet care needs and for receiving care and services that had not been agreed :lo, Findings included ... Resident 3 Review of an ALF Face Sheet dated 04/2912025 showed Resident 3 \/Vas admitted on /20.22 with multiple diagnoses including and . Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 10 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 previously worked for the ALF, and they did not do a new background check when they were re- hired. 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, SCRIBER GARDENS LLC 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-2150 Signing negotiated service agreement. The assisted living facility must ensure that the negotiated service agreement is agreed to and signed at least annually by: (1) The resident, or the resident's representative if the resident has one and is unable to sign or chooses not to sign; (2) A representative of the assisted living facility duly authorized by the assisted living facility to sign on its behalf; and This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure the Negotiated Service Agreement (NSA) was agreed to and signed at least annually by 2 of 7 residents (Resident 3 and Resident 7) or their representatives, and by a representative of the ALF. This failure placed the residents at risk for unmet care needs and for receiving care and services that had not been agreed to. Findings included… Resident 3 Review of an ALF Face Sheet dated 04/29/2025 showed Resident 3 was admitted on /2022 with multiple diagnoses including and . This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. NOV/0 02 RI 03:52 PM SCRIBER GARDENS FAX No. P. 0l l 11.06.2025 16:17:56 State of Washington 15/29 Statement of Deficiencies ·····L1cense #: 2203· • C'cififjlliance mitefrhination #'67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 11 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Review of an NSA, dated 12/13/2024, showed .a signature page wiih lines for the resident, the resident representative and an ALF representative to sig11. but there were no signatures. There was no evidence an NSA had been signed within the past 12 months. Reside[ll 7 Review of an ALF Face Sheet dated 10/15/2025 showed Resident 5 was admitted on 0/2018 with multiple diagnGses including l and . Review of an NSA, dated 07/15/2025, showed a signature page with lines for the resident, the resident representative and an ALF representative to sign, but there were no signatures. There was no evidence an NSA had been signed within the past 12 months. On 10/17/2025 at 2:13 PM, Staff H, Licensed Practical Nurse/Wellness Director, stated that they could not find the signed NSAs. 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, SCRIBER Gf RDVNS LLC is or will be in compliance with this law and / or regulation on (Date) I L, j~ J...';{'"" . r . In addition, I will implemant a system to monitor and ensure continued compliance with \his requirement. Date WAC 3·8.8"78A-2240 Nonavailability .of medications. When the assisted living facility has assumed respon$ibility for obtaining a resident's prescribed medications, the assisted living facility must obtain them in a correct and timely manner. This requirement was not met as evidenced by: Based on interview and record r-eview, the Assisted Living Facility (ALF) failed to obtain prescribed medications in a timely manner for 2 of 7 residents (Resident 1 and Resident 3). This failure resulted in Resident 1 and Resident 3 not receiving prescribed medications and placed them at risk for medical complications. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 11 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Review of an NSA, dated 12/13/2024, showed a signature page with lines for the resident, the resident representative and an ALF representative to sign, but there were no signatures. There was no evidence an NSA had been signed within the past 12 months. Resident 7 Review of an ALF Face Sheet dated 10/15/2025 showed Resident 5 was admitted on /2018 with multiple diagnoses including and . Review of an NSA, dated 07/15/2025, showed a signature page with lines for the resident, the resident representative and an ALF representative to sign, but there were no signatures. There was no evidence an NSA had been signed within the past 12 months. On 10/17/2025 at 2:13 PM, Staff H, Licensed Practical Nurse/Wellness Director, stated that they could not find the signed NSAs. 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, SCRIBER GARDENS LLC 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-2240 Nonavailability of medications. When the assisted living facility has assumed responsibility for obtaining a resident's prescribed medications, the assisted living facility must obtain them in a correct and timely manner. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to obtain prescribed medications in a timely manner for 2 of 7 residents (Resident 1 and Resident 3). This failure resulted in Resident 1 and Resident 3 not receiving prescribed medications and placed them at risk for medical complications. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 12 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Findings included... Review of the ALF’s policy titled “Medication Services” dated 07/14/2022 showed staff will ensure availability of all prescribed medications when the ALF has assumed responsibility for obtaining them. Resident 1 Review of an ALF Face Sheet dated 06/18/2025 showed Resident 1 was admitted on /2025 with multiple diagnoses including and . Review of a Care Plan dated /2025 showed the ALF would request and review Resident 1’s physician orders, confirm orders with the facility pharmacy and maintain monthly auto delivery to ensure medications were available and provided to Resident 1. Review of a Medication Administration Record (MAR) dated August 2025 showed Resident 1 was prescribed Estradiol (a synthetic female hormone that supports bone density, heart health and regulates mood and emotional well-being) once a week at bedtime. The MARs for August, September and October 2025 showed Estradiol was marked as not given from 08/31/2025 through 10/12/2025 (seven doses) stating “refill requested” and “results unavailable “as the reasons the medication had not been given. On 10/20/2025 at 10:30 AM, Staff I, Memory Care Director, stated that Estradiol had never been given to Resident 1 and that the memory care unit staff did not have the credentials or training to provide this type of medication. On 10/20/2025 at 4:43 PM, Staff H, Wellness Director (WD), stated that they were aware that the Estradiol had not been given and that the prescribing physician had not been contacted regarding the missing doses. Resident 3 Review of an ALF Face Sheet dated 04/29/2025 showed Resident 3 was admitted on /2022 with multiple diagnoses including and . Review of Resident 3’s Assessment dated 12/13/2024 showed the ALF would request and review Resident 3’s physician orders, confirm orders with the facility pharmacy and maintain monthly auto delivery to ensure medications were available and provided to This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. NOV/0 02 RI 03:52 PM SCRIBER GARDENS FAX No, P. 0l 3 11.~o.L~L~ 10:11:~u ~tate ot wasn1n9ton l l/Z9 statement of Deficiencies -- 0 • Eice·nse #' 2203 ComplianceDe1erminatlon # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 13 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 a. Resident Review of a MAR, dated October 2025, showed Resident 3 was prescribed Digoxin 0.125mg (milligram)/tablet (a medication that provides a stronger and more stable heartbeat). ½ tatilet tiy mouth once a day. The MAR showed Digoxin was marked as not given from 10/09/2025 through 10/14/2025 (6 doses) stating "refill retJuested" and "res1.1lts unavailable "as the reasons the medication had not given. On 10/20/2025 a14:44 PM, Staff Ii, WO, staled that they were not aware that the Digoxin had not been given and that th.e prescribing physician had not been contacted regarding the missing doses. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active meas1.1res to correct this deficiency. By taking this action, SCRIBER GtRDfNS LLC is or Z will be in compliance with this law and / or regulation on (Date) \ ~I~ . In addition, I will Implement a system to monitor and ensure continued compliance with this requirement. WAC 388-78A-2160 Implementation of negotiated .service agreement. The assisted living facility mu.st provide the care and services as agreed upon in the negotiated service agreement to each resident unless a deviation from the negotiated service agreement is mutually agreed upon between the assisted living facility 1md the resident or the resident's representative at the time the care or services are scheduled. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to provide care and services agreed upon in the resident's care plan for monthly weight checks and vital signs for 1 of 7 sampled residents (Resident 7). This placed Resident 7 at risk of complications due to unnoticed changes in weight and/or vital signs. Findings included , Review of an ALF Face Sheet dated 10/15/2025 showed Resident 7 was admitted on /2018 with diagnoses to include and Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 13 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Resident 3. Review of a MAR, dated October 2025, showed Resident 3 was prescribed Digoxin 0.125mg (milligram)/tablet (a medication that provides a stronger and more stable heartbeat), ½ tablet by mouth once a day. The MAR showed Digoxin was marked as not given from 10/09/2025 through 10/14/2025 (6 doses) stating “refill requested” and “results unavailable “as the reasons the medication had not given. On 10/20/2025 at 4:44 PM, Staff H, WD, stated that they were not aware that the Digoxin had not been given and that the prescribing physician had not been contacted regarding the missing doses. 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, SCRIBER GARDENS LLC 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-2160 Implementation of negotiated service agreement. The assisted living facility must provide the care and services as agreed upon in the negotiated service agreement to each resident unless a deviation from the negotiated service agreement is mutually agreed upon between the assisted living facility and the resident or the resident's representative at the time the care or services are scheduled. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to provide care and services agreed upon in the resident’s care plan for monthly weight checks and vital signs for 1 of 7 sampled residents (Resident 7). This placed Resident 7 at risk of complications due to unnoticed changes in weight and/or vital signs. Findings included… Review of an ALF Face Sheet dated 10/15/2025 showed Resident 7 was admitted on /2018 with diagnoses to include and This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. !JOV/0 02 RI 03: 52 PM SCRIBER GARDENS FAX No. P. 0l 4 11,t'.JIJ,lt'.Jl:J lb: I flot> ~tHtij Ut wa~n111~tUII Ill/ LJJ Statement" ofDeficiericies· '·Utense #: 2203'' Compliance Determination # 67z!31 •• Pl!iln of Correction SCRIBER GARDENS LLC Completion Date Page 14 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 . Review of Physician Orders dated 09/20i2018 showed Resident 7 would need a weight check ,md vital signs monitored monthly. Review of the ALF's Self Medication Assessment dated 10/20/2025 showed Resident 7 required monthly weight checks and vital sign monitoring, Review of the Electronic Medication Administration Records (EMAR's) dated August 2025, September 2025 and October 2025, showed no monthly weight check or vit!ill signs had been completed or documented. On 10/20/2025 at 4:47 PM, Staff H, Wellness Director. could not explain why weight checks and vitals sign hsd not been completed monthly far the resident. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will t1;1ke active measures to correct this deficiency. By taking this action, SCRIBER G/1,RDENS LLC is or l 2:. /Jj/J:::;{" . will be in compliance with this la.w ani:;t / or regulation on (Date) In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Date WAC 388-78A·2210 Medication services. (1) An sssJsted living facility providing medication service, either directly or indirectly, must: (b) Develop and implement systems that ,supp.ort and promote safe medication service for each resident (2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388•78A-2230 ,ind 388-78A-2.250: (a) Each resident who requires medication assistance and his.or her negotiated service agreement indicates. the assisted living facility will provide medication assistance; and (b) If the assisted living facility provides medication admin_istration services, each resident w,ho requires medication administration and his or her negotiated service Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 14 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 . Review of Physician Orders dated 09/20/2018 showed Resident 7 would need a weight check and vital signs monitored monthly. Review of the ALF’s Self Medication Assessment dated 10/20/2025 showed Resident 7 required monthly weight checks and vital sign monitoring. Review of the Electronic Medication Administration Records (EMAR’s) dated August 2025, September 2025 and October 2025, showed no monthly weight check or vital signs had been completed or documented. On 10/20/2025 at 4:47 PM, Staff H, Wellness Director, could not explain why weight checks and vitals sign had not been completed monthly for the resident. 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, SCRIBER GARDENS LLC 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-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (b) Develop and implement systems that support and promote safe medication service for each resident. (2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250 : (a) Each resident who requires medication assistance and his or her negotiated service agreement indicates the assisted living facility will provide medication assistance; and (b) If the assisted living facility provides medication administration services, each resident who requires medication administration and his or her negotiated service This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 15 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 agreement indicates the assisted living facility will provide medication administration. This requirement was not met as evidenced by: Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to develop and implement safe medication services to ensure 5 of 7 residents (Resident 1, Resident 2, Resident 3, Resident 4 and Resident 6) received their medications as prescribed by a physician, and ensured accurate documentation of medication services. This failure resulted in residents not receiving medications as prescribed and resulted in inaccurate medication administration documentation. Findings included… Review of the ALF’s policy titled “Medication Services,” dated 07/14/2022, showed that the staff responsible for supervision of medication assistance must document in the medication administration record indicating the medication was taken appropriately. The policy also indicated that staff names and matching initials were found at the bottom of the medication administration record. Resident 1 Review of an ALF Face Sheet dated 06/18/2025 showed Resident 1 was admitted on /2025 with multiple diagnoses including and . Review of a Care Plan dated 07/02/2025 showed the ALF would request and review Resident 1’s physician orders, confirm orders with the facility pharmacy, maintain monthly auto delivery to ensure medications were available and provide medication administration to Resident 1. Review of a Medication Administration Record (MAR) dated August 2025 showed Resident 1 was prescribed Vitamin D 50,000 units, take 1 capsule by mouth monthly on the 1st. The EMAR’s dated August 2025, September 2025 and October 2025 showed no documentation of Vitamin D provided. On 10/20/2025 at 9:45 AM, Staff H, Licensed Practical Nurse (LPN)/Wellness Director (WD), stated that Resident 1’s Vitamin D order was put in the system as a PRN (as needed) order and not given. Resident 2 Review of a face sheet, dated 06/18/2025, showed Resident 2 admitted to the ALF on /2025 with diagnoses to include . This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 16 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Review of Resident 2’s negotiated service agreement, dated 04/17/2025, showed the resident required medication assistance. Review of Resident 2’s Medication Administration Records (MARs) from 08/01/2025 – 10/15/2025 showed ALF staff had documented that they administered the resident a daily dose of Aspirin 81 milligrams (mg). On 10/17/2025 at 9:01 AM, five bottles of medications were observed sitting on the kitchen sink of Resident 2’s apartment, to include a bottle of Aspirin 325 mg. Resident 2 stated that they took their own aspirin daily and that they did not receive Aspirin from ALF staff. On 10/17/2025 at 12:12 PM, Staff H, LPN/WD, stated that Resident 2 had bought their Aspirin over the counter, and that they took the resident’s medications out of their room today. Review of Resident 2’s September 2025 MARs showed documentation that Staff C, Caregiver, (this caregiver did not have tasks delegated by a registered nurse), had administered Resident 2 Aspirin, Roflumilast (a medication to treat chronic inflammatory diseases), and Tamsulosin (a medication to treat symptoms of an enlarged prostate). Resident 3 Review of an ALF Face Sheet dated 04/29/2025 showed Resident 3 was admitted on /2022 with multiple diagnoses including and . Review of Resident 3’s assessment dated 12/13/2024 showed the ALF would request and review Resident 3’s physician orders, confirm orders with the facility pharmacy and maintain monthly auto delivery to ensure medications were available and provided to Resident 3. Review of Resident 3’s October 2025 MARs showed that the ALF staff documented they administered 4 injections of FLUAD (an annual influenza vaccine). On 10/20/2025 at 2:33 PM, Staff I, Memory Care Director, stated that regarding the FLUAD injection documentation, staff had told them (Staff I) they thought that it was for fluid monitoring and had not given the injection as it was ordered. Resident 4 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 17 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 Review of a face sheet, dated 10/15/2025, showed Resident 4 admitted to the ALF on /2025 with diagnoses to include and . Review of Resident 4’s August 2025, September 2025, and October 2025 MARs showed that Staff D, Caregiver, documented that they did numerous insulin injections and blood sugar checks. Review of Resident 4’s September 2025 MARs showed that Staff C, Caregiver (this caregiver had not been delegated tasks by the registered nurse delegator), on 09/02/2025 at 7:30 AM, that they administered the resident an insulin injection and that they checked the resident’s blood sugar. The MARs also showed that Staff C administered the resident Amlodipine (a blood pressure medication), Atorvastatin (a cholesterol lowering medication), folic acid (a medication to help the body produce red blood cells), Pantoprazole (a medication used to reduce stomach acid), Sertraline (an antidepressant medication), Tamsulosin, Vitamin B1, and mucus relief tabs. Review of Resident 4’s October 2025 MARs showed documentation that Staff C had administered the resident multiple doses of Hydroxyzine (medication being used for anxiety or itching). Review of Resident 4’s October 2025 MARs showed that ALF staff had documented they had administered the resident six injections of FLUAD. Resident 6 Review of a face sheet, dated 10/15/2025, showed Resident 6 admitted to the ALF on /2025 with diagnoses to include and . Review of Resident 6’s August 2025 MARs showed that Staff C, Caregiver, had administered two doses of Hydrocodone/Acetaminophen (a pain medication) and they had documented four times that they had assessed the effectiveness of that medication. Review of Resident 6’s September 2025 MARS showed that Staff C, Caregiver, had administered the resident Bumetanide (a diuretic medication to treat fluid retention), Hydrocodone/Acetaminophen, and Methocarbamol (a muscle relaxant medication). This review also showed documentation that Staff D, Caregiver (this caregiver had not been delegated tasks by the registered nurse delegator), had documented that they administered Humalog insulin to the resident. Review of Resident 6’s October 2025 MARS showed documentation that Staff C, Caregiver, had administered the resident seven doses of Hydrocodone/Acetaminophen. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. !JOV/0 02 RI 03: 53 PM SCRIBER GARDENS FAX No. P. 0l 8 I I ,VU,UJL,J m; 11 ;Ju \H,dl,~ ur Mtl:Jll 111~1.UII llll~ ~-- ······ -·--~='stet.eiemm-eieniilt 0 c0c~f,i§1EJiiiefliie1ciJ.ieiii1W'iiili.ie,=F--:.=c:-:cc:-=====:.:. ; .:.;:.; : c•-::j·1= 0 ic1ii1:,c<e•eitini.is•lf~"lr:~22:>10rnJ,:C·.·.·.".': c:.=··«·c':J·o!iimillpill1iiiitniiic~·ecf-13liemte~i'i'i'ilffii'ififill!tlliioll'jjf.'j·#~'6~7Mi,?i(i:(l'l¥"·""·=.-e. ----· Plan of Correction SCRIBER GARDENS LLG Completion D~te Page 18 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 On 10/16/2025 at 1: 16 PM, Staff A, Executive Director, stated that Staff C and Staff D had not been delegated tasks by their nurse delegator, On 10/17/2025 at 12:12 PM, Staff H, LPN/WO, stated that Staff D cannot administer insulin i'njections and Staff C cannot administer any medications. On 10/17/2025 at 12:28 PM, Staff H, LPN/Wb, stated that Staff C did not give-the me\'.lications that the residents' MARs showed. They stateid that the problem was with staff nol sig11ing out of the computer, and other staff not reali,dng it and documenting medications as given using another staff's initials. On 10/20/2025 at 4:39 PM, Staff H, LPN/WO, stated that the pharmacy had put the FLUAD order on the MAR after the injection had been provided by the pharmacy. Staff H stated that they had not_ reviewed the order for accuracy, On '10/22/2025 at 2 31 PM, Staff C, stated that they had not administe1·ed any medications, they had not done any insulin inject'lons, and they had not checked any blood sugars. Refer to WAC 388-78A-232O lntermitterit Nursing Services Systems. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this di,;liCiency, By taking this action, SCRIBER½u,' RD!NS J._,LC is or l . will be in compliance with this law and/ or regulation on (Date) \. '61-►J In addition, ! will implement a system to monitor and ensure continued compliance with th.is requirement. Administrator (or Representative)~~ Date})-1-¥ Statement of Deficiencies License #: 2203 Compliance Determination # 67231 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 18 of 18 Licensee: SCRIBER GARDENS LLC 10/30/2025 On 10/16/2025 at 1:16 PM, Staff A, Executive Director, stated that Staff C and Staff D had not been delegated tasks by their nurse delegator. On 10/17/2025 at 12:12 PM, Staff H, LPN/WD, stated that Staff D cannot administer insulin injections and Staff C cannot administer any medications. On 10/17/2025 at 12:28 PM, Staff H, LPN/WD, stated that Staff C did not give the medications that the residents’ MARs showed. They stated that the problem was with staff not signing out of the computer, and other staff not realizing it and documenting medications as given using another staff’s initials. On 10/20/2025 at 4:39 PM, Staff H, LPN/WD, stated that the pharmacy had put the FLUAD order on the MAR after the injection had been provided by the pharmacy. Staff H stated that they had not reviewed the order for accuracy. On 10/22/2025 at 2:31 PM, Staff C, stated that they had not administered any medications, they had not done any insulin injections, and they had not checked any blood sugars. Refer to WAC 388-78A-2320 Intermittent Nursing Services Systems. 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, SCRIBER GARDENS LLC 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.

—: WA DSHS report: Investigations (01/2025)

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: SCRIBER GARDENS LLC Provider Type: Assisted Living Facility License/Cert.#: 2203 Compliance Determination #: 37676 Intake ID: 119658 Investigator: Wesler Dumecquias Region/Unit #: RCS Region 2 / Unit A Investigation Date(s): 03/04/2024 through 04/11/2024 Complainant Contact Date(s): 03/04/2024 Allegation(s): 1. Named residents (NR1 and NR2) had long call wait times, resulting in NR1 falling 2x and being sent to the emergency room, as well as a delay in NR2’s brief being changed. 2. The Assisted Living Facility (ALF) was short staffed and had only one caregiver overnight. Investigation Methods: Sample: Total residents: 43 Resident sample size: 3 Closed records sample size: 0 Observations: Identified residents Activities Dining Resident rooms Resident care equipment Resident to resident interactions Staff to resident interactions Interviews: Identified residents Nursing staff Residents Family members Record Reviews: Incident investigation Facility policies Care plans Home health and PT notes Toileting records. Investigation Summary: 1. The Assisted Living Facility (ALF) had issues with their call pendants not functioning. Three of the three sampled residents stated they had to wait longer for staff to come and help them when they called. Two of the three sampled residents had intermittently nonfunctioning call pendants. Observation showed that 2 of the call pendants were not transmitting an alert on the ALF staff's pagers when tested. A failed practice was This document was prepared by Residential Care Services for the Locator website. identified. A citation was issued for noncompliance with WAC 388-78A-2930(1) (b) (i)—communication system. 2. The ALF was continuously hiring for staff. Interviews with sampled residents showed they were not concerned with the staffing but stated they had issues with long waits sometimes with staff responding and pendants not always working. A failed practice was identified. A citation was issued for noncompliance with WAC 388-78A-2930(1) (b) (i)—communication system. 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. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALT H SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 3906-172nd St NE, Suite #100, Arlington, WA 98223 10/16/2024 SCRIBER GARDENS LLC SCRIBER GARDENS LLC 6024 200TH ST SW LYNNWOOD, WA 98036 RE: SCRIBER GARDENS LLC # 2203 Dear Administrator: This letter addresses deficiencies occurring in the report(s) for: Compliance Determination(s) 48835 (Completion Date 10/16/2024) and 44410 (Completion Date 08/15/2024). The Department completed a follow-up inspection of your Assisted Living Facility on 10/16/2024 and found no deficiencies. The Department found that deficiencies for the following licensing laws and regulations were corrected: WAC 388-78A-2610 Infection control. (2) The assisted living facility must: (a) Develop and implement a system to identify and manage infections; (f) Report communicable diseases in accordance with the requirements in chapter 246-100 WAC. WAC 388-78A-2040 Other requirements. (1) The assisted living facility must comply with all other applicable federal, state, county and municipal statutes, rules, codes and ordinances, including without limitations those that prohibit discrimination. The Department staff who did the On Site verification: Wesler Dumecquias, Community Complaint Investigator If you have any questions, please contact me at (360)651-6846. This document was prepared by Residential Care Services for the Locator website. Sincerely, Kimberley Ripley, Field Manager Region 2, Unit A Residential Care Services Residential Care Services Investigation Summary Report Provider/Facility: SCRIBER GARDENS LLC Provider Type: Assisted Living Facility License/Cert.#: 2203 Intake ID: 137689 Compliance Determination #: 44410 Region/Unit #: RCS Region 2 / Unit A Investigator: Wesler Dumecquias Investigation Date(s): 07/19/2024 through 08/15/2024 Complainant Contact Date(s): 07/17/2024 Allegation(s): There were multiple residents who were sick, throwing up and taken to the hospital. The Assisted Living Facility were on droplet precautions but did not quarantine the sick residents. Investigation Methods: Sample: Total residents: 43 Resident sample size: 7 Closed records sample size: 2 Observations: Residents Activities Dining Staff to resident interactions Resident to resident interactions Interviews: Nursing staff Residents Family members Record Reviews: Facility policies Care plans Progress notes Staff list N95 fit tests and Medical Clearances. Investigation Summary: The Assisted Living Facility (ALF) had residents who were ill and exhibited signs and symptoms compatible with a COVID-19 infection. A resident tested positive with COVID-19 after the ALF sent them to the hospital. The Sampled Residents experienced symptoms that were compatible with a COVID-19 infection. Interviews indicated that the ALF's Memory Care Unit staff used personal protective equipment when providing care to residents with cold-like symptoms. The ALF failed to investigate to determine if they had an outbreak. The ALF did not report to the Department of Health (DOH) for the issuance of guidelines, including the need to test the residents who had symptoms compatible with COVID-19, and did not report This document was prepared by Residential Care Services for the Locator website. to the Complaint Resolution Unit Hotline. Failed practice was identified. A citation was issued for noncompliance with WAC 388-78A-2650 (3) Reporting Fires and Incidents and WAC 388-78A- 2371 (1)- Investigations. 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. Ii □ □ This document was prepared by Residential Care Services for the Locator website. 08.16.2024 15:39:35 State of Washington 5/14 STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 3906-172nd St NE, Suite #100, Arlington, WA 98223 sfatemerit·or oeticlendes···• •••• ••••• License #: 220s tonipiiarice oeform,natfon # 44410 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 1 of7 Licensee: SCRIBER GARDENS LLC 08/15/2024 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 complaint investigation on 07/19/2024 and 07/19/2024 of: SCRIBER GARDENS LLC 6024 200TH ST SW LYNNWOOD. WA 98036 This document references the following complaint nLlmber(s): 137689 Tl1e following sample was selected for review during the unannounced on-site visit: 7 of 43 current residents and 2 former residents. The department staff that investigated the Assisted Living Facility: Wesler Durnecquias. Commlmity Complaint Investigator From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit A 3906-'172nd St NE, Suite #100 Arlington, WA 98223 As a ~esult of the on-site visit(s), the department found tl1at you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. ~ · ~- 08/16/2024 ................................... t,/,')1,,--·.::;·{--.:.-~-~£-:. ..................................... . 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. This document was prepared by Residential Care Services for the Locator website. 08.16.2024 15:39:35 State of Washington 6/14 Statement of Deficiencies License #: 2203 Compliance Determination# 44410 Plan of Correction SCRIBER GARDENS LLC Completion Date Pag~ 2 of7 Licensee: SCRIBER GARDENS LLC 08/15/2024 Adn,inistr·a· tor (or ~res~rtative) ~~~~~ WAC 388-78A-2610 Infection control. (2) The assisted living facility must: (a) Develop and implement a system to identify and manage infectio11s; (f) Report communicable diseases in accordance with the requirements in chapter 246-100 WAC. This requirement was not met as evidenced by: Based on interviews and record review, the Assisted Living Facility (ALF) failed to determine if 4 of 5 residents (Resident 2, 3, 4, and 5) who were displaying signs of sickness after another memory care resident (Resident 1) and one staff (Staff E) tested positive for coronavirus 2019 (COVID-19) (a very contagious disease caused by a virus named SARS-CoV-2.) had a communicable disease and failed to report the positive cases of COVI D-19 to the local healt11 department. These failures resulted in all four residents displaying illness without being tested and placed all residents at risk of contracting and spreading COVID-19 infections. Findings included ... The Assisted Living facility (ALF) poHcy titled "INFECTION CONTROL Policy and Procedure Number: S7," dated 04/28/2023 showed the community shall report when a resident or staff member contracts a reportable infectious disease to the local health department (LHD) and provide them with the name, address, age, sex, diagnosis, or suspected diagnosis of disease or condition, phone number of person having reportable disease (S) and the name, address or telephone number of the person providing the report. The policy showed COVID-19 as a category "A" disease and conditions that were reportable immediately when a case was suspected or diagnosed. The ALF policy titled "INFECTION CONTROL-RESPIRATORY OUTBREAK RESPONSE" (Policy) dated 03/28/2024 showed COVID-19 testing for the COVID-19 virus can help residents decide what to do next, like getting treatment to reduce your risk of severe illness and taking steps to lower their chances of spreading a virus to others. The Policy showed the ALF would report all suspected or confirmed cases of respiratory illness to the Local Health Jurisdiction. Review of the Assisted Living Facility Guidebook Partners in Protection, dated February This document was prepared by Residential Care Services for the Locator website. 08.16.2024 15:39:35 State of Washington 7114 Statement of Deficiencies License #: 2203 Compliance Determination# 44410 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 3 of 7 Licensee: SCRIBER GARDENS LLC 08/15/2024 2018, contained guidelines intended to assist facilities in developing and implementing policies and procedures to help prevent resident abwse, neglect, abandonment, significant injuries of unknown source, or personal and financial exploitation by any person. Chapter 1 and Appendix D showed the state law required the assisted living facility to report to the Department of Social and Health Services hotline and the local health department when an ALF had a communicable disease outbreak. Resident 1 Resident 1 was admitted to the ALF on /2022 with multiple diagnoses including On 07/19/2024 at 2: 17 PM, Staff A, Executive Director, stated that they sent Resident 1 to the hospital 07/05/2024 due to difficulty breathing. Resident 1 tested positive for COVID-19 at the hospital on 07/05/2024. Staff A stated that they did not have an incident report or investigation because "Resident 1 tested positive in the hospital". They did not report to the Snohomish Local Health jurisdiction or to the DSHS Hotline because they believed they did not have an outbreak. Staff A stated that they did not do contact tracing and testing because they were not allowed to test. On 07/26/2024 at 3:41 PM, Staff C, memory care coordinator, stated that Resident 1 was sent to the hospital on 07/05/2024 and tested positive for COVID-19 infection. Staff C state.d that they were not allowed to test their residents because they were not certified to do testing. Resident 2 Resident 2 was admitted to the ALF on /2020 with multiple diagnoses including . Review of Alert charting dated 07/08/2024 showed Resident 2 was on alert charting for coughing and runny nose. Resident 3 Resident 3 was admitted to the ALF on /2023 with multiple diagnoses including This document was prepared by Residential Care Services for the Locator website. 08.16.2024 15:39:35 State of Washington 8/14 Statement of Deficiencies License#: 2203 Compliance Determination# 44410 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 4 of 7 Licensee: SCRIBER GARDENS LLC 08/15/2024 Review of alert charting dated 07/08/2024 showed Resident 3 was on alert charting for Sllspected COVID-19 symptoms. Resident 4 Resident 4 was admitted on /2023 with multiple diagnoses including . Review of alert charting dated 07/11/2024 showed Resident 4 was on alert charting for signs and symptoms of COVI DH19. Resident 5 Resident 5 was admitted to the ALF on /2021 with multiple diagnoses including Review of alert charting dated 07/08/2024 showed Resident 5 was on alert charting for cold symptoms. On 07/19/2024 at 2:06 PM, Staff D, Caregiver, stated that there were two residents (Resident 2 and 5) they observed having symptoms such as coughing, congestion, sore throat, and did not have an appetite to eat. Staff D stated that they quarantined the residents in the memory care unit. They had personal protective equipment carts set up, airborne precaution signages on the residents' apartment doors who had symptoms, and the staff were wearing PPE and N95 when entering the residents' rooms. On 07/19/2024 at 2:49 PM, Staff E, Med Tech, stated that they observed four residents (Residents 2, 3, 4 and S) with cough, congestion, sore throat, and no appetite. Staff E stated that they also had the symptoms of COVID-19, tested positive, and stayed home. Staff Estated that they contracted the infection while working with the residents who had symptoms. On 07/19/2024 at 3:03 PM, Staff F, Med Tech, stated that residents had symptoms compatible with COVID-19 infection, such as coughing, congestion, and weariness. Staff F stated they were using PPE and had the PPE cart set up and signs for precautions. On 07/19/2024 at 3:09 PM, Staff G, caregiver stated that they observed residents 2 and This document was prepared by Residential Care Services for the Locator website. 08.16.2024 15:39:35 State of Washington 9/14 Statement of Deficiencies License#: 2203 Compliance Determination # 44410 Plan of Correction SCRIBER GARDENS LLC Completion Date Page S of 7 Licensee: SCRIBER GARDENS LLC 08/15/2024 3 with cough, runny nose, and congestion. Staff G stated that t11ere were airborne and droplet precaution signages posted by the residents' door and personal protective equipment carts were placed. Staff G stated that they were wearing N95 when they went into residents 2 and 3's room to provide care. On 07/26/2024 at 2:18 PM, Staff H, Regional Nurse. stated that they do report outbreak cases to the LHJ. Staff H stated they were not aware the ALF did not report to the Local Health Jurisdiction. Staff H stated they would do broad.based testing if they had an outbreak. On 07/22/2024 at 10:30 AM, Collateral Contact 2 (CC2). Infection Preventionist for Snohomish County, stated that they did not receive any reports of COVID~19 cases from the ALF. CC2 noted that they do not have a record from the ALF that they had instances of COVID-19 reported in July 2024. 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, SC RIBAR aGA Rc7D -ENS LLC is or will be in compliance with this law and I or regulation on (Date) :j- ':JLL . In addition, I will implement a system to monitor and ensure continued compliance with tl1is requirement. ~~ ~ \-~. .. -~ ·~l9~F?.~l .. .. Administra~ (or Representative) Date WAC 388-78A-2040 Other requirements. (1) The assisted living facility must comply with all other applicable federal, state, county and municipal statutes, rules. codes and ordinances, including without limitations those that prohibit discrimination. This requirement was not met as evidenced by: Based on interviews and record reviews the Assisted Living Facility (ALF) failed to ensure a medical testing site waiver (MTSW) license was obtained to complete blood glucose testing for 2 of 2 residents (Resident 6 and 7). This failure resulted in the ALF not maintaining compliance with Washington State MTSW licensure requirements and the minimum standards. The failure placed Resident 6 and 7 at risk for having inaccurate and unreliable clinical laboratory services and test results. Findi11gs included ... Review of the Washington State Department of Health website https://doh.wa.gov/licenses-permits and-certificates/facilities-z/medical-test-sites-mts on 08/15/2024, This document was prepared by Residential Care Services for the Locator website. 08.16.2024 15:39:35 State of Washington Statement of Deficiencies License#: 2203 Compliance Determination# 44410 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 6 of 7 Licensee: SCRIBER GARDENS LLC 08/15/2024 tJC:IIUIIII lC::>L::> UII t:I f-'~1.:>VII IUI LIIC tJUltJV;:>C Ul Ult:ll:JIIV;:11;)., llCCJllll'C::111, VI p1cv1::11uu11 VI '-!l;)l::Cl.:>C:. Roviow of ;)n ALF provider latter d::itod 08/03/2022 titled, Medical Toc;t Site Wo.ivor Regulatory Requirements; informed ALF providers of state and federal regulations that were related to certain types of medical testing such as COVID-19 and blood glucose testing which required a MTSW licensure. The letter showed when the ALF administers a medical test such as COVID-19 or blood glucose test, interprets the results, or acts upon tl1e test results a MTSW license waiver would be reqLtired. Resident 6 Resident 6 was admitted on /2024 with multiple diagnoses, including . A review of the Physician's order dated 07/14/2024 showed Resident 6 had an order for the ALF staff to test blood Sligar three times daily as directed by the primary care physician. Resident 7 Resident 7 was admitted on /2024 with multiple diagnoses, including . A review of the Physician's order dated 07/19/2024 and 08/01/2024 showed Resident 7 had an order for the ALF staff to assist in the administration of long-acting and short-acting insulin injections, respectively, for their DM2. A review of the care plan dated 07/22/2024 showed Resident 7 had blood sugar checks three times a day done by the ALF staff. Resident 7 would come to the medication cart/Med Tech to have their blood sugar checked On 08/15/2024 at 11 :55 AM, Staff l, Med Tech, stated that Residents 6 and 7 had a sliding scale order to administer insulin. Staff I would need to check their blood sugars using a glucometer machine (is used to measure how much sugar is in the blood sample), read the results, and record them in their Quick MAR (a software system used by the Assisted Living Facility to organize, manage, record and document the name of the medication, dose taken, special instructions and date and time). The readings would be th'e basis for how much insulin Residents 1 and 2 would receive. On 07/26/2024 at 1 :43 PM, Staff A, Executive Director, stated that they would 11ot test residents for COVID-19 because, according to their corporate office, they no longer have This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License#: 2203 Compliance Determination # 4441 0 Plan of Correction SCRIBER GARDENS LLC Completion Date Page 7 of 7 Licensee SCRIBER GARDENS LLC 08/15/2024 Clinical Laboratory Improvement Amendments (CUA) waiver or MTSW. On 08/15i2024 at 12:09 AM, Staff A stated that the ALF did not have a CLIA/MTSWwaiver and would inform their corporate office. 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, SCRIBER GARDENS LLC 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: SCRIBER GARDENS LLC Provider Type: Assisted Living Facility License/Cert.#: 2203 Compliance Determination #: 22719 Intake ID: 77341 Investigator: Wesler Dumecquias Region/Unit #: RCS Region 2 / Unit A Investigation Date(s): 04/19/2023 through 05/15/2023 Complainant Contact Date(s): 04/12/2023, 05/12/2023, 05/17/2023 Allegation(s): 1. The Named Resident (NR) was given five wrong medications that may have caused serious side effects. 2. There was lack of resident identifier and medications were given crushed and mixed with apple sauce. 3. NR was found on the floor in another resident’s room. 4. There was no adequate staffing. 5. The resident rooms were locked. 6. The NR's blood pressure was only to be measured when staff had time. The NR's well being was not taken care of in relation to the medication error. 7. The facility had no Executive Director to address the concerns. Investigation Methods: Sample: Total residents: 46 Resident sample size: 5 Closed records sample size: 2 Observations: Identified resident Residents Dining Resident rooms Staff to resident interactions Resident to resident interactions Medication administration Interviews: Identified resident Identified staff Nursing staff Regional Nurse Executive Director Residents Family members Record Reviews: Incident investigation Facility policies Personnel files Staff training records Medication administration records This document was prepared by Residential Care Services for the Locator website. Care plan Physician orders facility alert and monitoring sheets. MD notification Charting notes Staff Schedules In service for medication services. Investigation Summary: It was determined: 1. The Assisted Living facility (ALF) conducted an investigation and found the staff committed a medication error. Findings indicated that the staff was distracted and was talking to another resident while giving medications. As a result, staff accidentally gave the medication to the NR who switched seat to another resident. The facility followed Assisted Living Guide Book in completing their investigation. Staff had 1:1 retraining on medication assistance and administration. The facility reviewed the staff's training and certification. The facility placed the NR on alert, monitoring and contacted the primary care physician (PCP) for advise. The facility notified the NR's family. There was no resident outcome identified as a result. No failed practice identified. 2. The facility has a system in place for residents' identification prior to giving medications. The MedTechs (MT) or Licensed nurses (LN) uses resident's photos, compares room numbers in the computers and they asked residents their names. The MT's and LN's were giving the NR and sampled resident (SR) medications in an altered or crushed form without physicians' orders. Failed Practice identified. WAC 388-78A-2250 (1)(4); Alteration of medications. 3. The NR wanders around the hallway and at times enters residents' rooms. The facility placed the resident on monitoring for the wandering behavior and the care plan was updated. The facility investigated the alleged fall and ruled out abuse and neglect. The NR was found in another residents' room sitting on the floor. The NR had no recollection of the incident. The resident was placed on alert charting and monitoring. No failed practice identified. 4. The facility has 2 caregivers and a MedTech for day and evening and a caregiver and a MedTech for the night shift on their Memory care unit. Observation during unannounced visit showed that staff were able to provide the care to the residents. The facility has a system in place during staff breaks to maintain staff presence. Interview of sampled residents indicated satisfaction with their care and services. 5. Observation showed that NR was able to access his room and was not locked. Other resident who are able are provided keys for them to lock and open their rooms. Observation and Interview with sampled resident showed that they are able to get in and out of their rooms. Staff interview indicated that rooms of residents are not being locked. No failed practice identified. 6. The NR was placed on alert charting and monitoring as documented in their computer system narrative charting. The facility has a communication log regarding issues, concerns and incident reports. Record review showed the primary care physician instructed the facility to monitor for sedation and adverse effects. Records review and Staff interview showed and indicated that the NRs' vital signs, sedation status, activities and possible adverse reactions were monitored. No resident outcome. No failed practice identified. 7. The facility hired a new Executive Director who officially started on 04/10/2023. The facility had regional administrators as designees to contact for concerns in the absence of the Executive Director. 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. This document was prepared by Residential Care Services for the Locator website.