Mukilteo Memory Care.

This document was prepared by Residential Care Services for the Locator website. 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 . .

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

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written . N/A . Investigation Summary Report Provider/Facility: Mukilteo Memory Care Provider Type: Assisted Living Facility License/Cert.#: 2426 Compliance Determination #: 36058 Intake ID: 115447 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 01/30/2024 through 03/28/2024 Complainant Contact Date(s): Allegation(s): 1. The Named Resident (NR) was involved in a Resident-to-Resident altercation at the Assisted Living Facility (ALF). Investigation Methods: Sample: Total residents: 59 Resident sample size: 17 Closed records sample size: Observations: Identified resident Residents Resident to resident interactions Staff to resident interactions Interviews: Identified resident Nursing staff Family members Record Reviews: State reporting log Incident investigation Facility policies Resident Records Investigation Summary: 1. Record review showed the NR had a history of resident-to-resident altercations. Review of the incident showed the NR began hitting the resident, when asked to leave the apartment. The ALF made all the appropriate notifications including a call to the NR's family representative. The ALF failed to implement the negotiated service agreement to provide monitoring and supervision the of the NR, resulting in other resident-to-resident altercations to occur. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written . N/A . Investigation Summary Report Provider/Facility: Mukilteo Memory Care Provider Type: Assisted Living Facility License/Cert.#: 2426 Compliance Determination #: 36058 Intake ID: 120459 Investigator: Michelle Mcglon Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 01/30/2024 through 03/28/2024 Complainant Contact Date(s): Allegation(s): 1. The Named Staff (NS) deliberately threw medications in the garbage for 15 memory care residents. Investigation Methods: Sample: Total residents: 59 Resident sample size: 17 Closed records sample size: Observations: Residents Staff to resident interactions Resident to resident interactions Medication administration Interviews: Identified staff Nursing staff Family members Record Reviews: State reporting log Incident investigation Facility policies Resident Records Staff training records Investigation Summary: 1. Interview and record review showed the NS intentionally threw the medications for 14 residents in to the garbage. The NS confirmed that she threw the medications in the garbage. The Assisted Living Facility (ALF) failed to ensure the NS had the required crendentials to provide care and services and administered medications to residents. The ALF failed to ensure medication systems were in place to promote safe medications services. The ALF failed to report to Department, when the NS threw medications in the garbage placing the residents at risk for harm. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written . Failed Provider Practice Not Identified / No Citation Written N/A . . .

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

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

Statement of Deficiencies License #: 2426 Compliance Determination # 27086 Plan of Correction Mukilteo Memory Care Completion Date Administrator (or Representative) Date WAC 388-78A-2130 Service agreement planning. The assisted living facility must: (3) Review and update each resident's negotiated service agreement consistent with WAC 388-78A- 2120 : (a) Within a reasonable time consistent with the needs of the resident following any change in the resident's physical, mental, or emotional functioning; and (b) Whenever the negotiated service agreement no longer adequately addresses the resident's current assessed needs and preferences. This requirement was not met as evidenced by: Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to ensure the Negotiated Service Agreement (NSA) was updated to reflect the care and service needs related to the current health status for 3 of 3 sampled residents (Residents 3, 4 and 5). This placed Residents 3, 4 and 5 at risk for having their health adversely affected by not receiving needed care and services. Findings included… RESIDENT 3 Review of a Resident Information (RI) form showed the ALF admitted Resident 3 on /2022 with multiple diagnoses including Review of a Physician Notification Form, dated 06/22/2023, showed Resident 3’s Primary Care Provider (PCP) ordered wound care after he had fallen out of bed sustaining an abrasion on his left forearm (LFA). Review of a Weekly Wound Skin Check (WWSC) form, dated 07/03/2023, showed Resident 3 had that had a LFA abrasion that measured 5.6 centimeters (cm) x 1.5 cm, and staff would continue the current wound care. Review of a WWSC form, dated 07/13/2023, showed the abrasion on Resident 3's LFA measured 0.3 cm x 0.3 cm, and a scab was observed. Review of a WWSC form, dated 07/20/2023, showed the abrasion on Resident 3's LFA measured 5.6 cm x 1.5 cm, it had reopened, and the scab was not intact. Review of a Progress Note (PN), dated 07/02/2023, showed Resident 3 was noted to have multiple scabs on both lower legs, toes, and hands, and was constantly picking on them. The PN stated that the PCP prescribed to apply Hydrocortisone cream (used to treat . Statement of Deficiencies License #: 2426 Compliance Determination # 27086 Plan of Correction Mukilteo Memory Care Completion Date redness, swelling, itching, and discomfort of various skin conditions) to affected area. Review of a PN, dated 07/05/2023, showed Resident 3 still had scabs on both hands, and was seen picking at a scab on the left hand. Review of a PN, dated 07/17/2023, showed Resident 3 developed open skin areas on the left first and second toes, and the PCP ordered wound care for them. Observation, on 07/25/2023 at 10:08 AM, showed an uncovered a scab on Resident 3's LFA and multiple scabs on the right elbow. Review of Resident 3's Service Plan (SP- equivalent to NSA), dated 07/08/2023, showed no information addressing Resident 3's ongoing skin issues. Review of the SP showed no interventions for Resident 3's skin breakdown or related behavior, such as picking at scabs. RESIDENT 4 Review of an undated RI form showed the ALF admitted Resident 4 on /2018 with multiple diagnoses including and Review of the SP, dated 07/07/2023, showed Resident 4 required maximum assistance with activities of daily living (ADLs - a term used in healthcare to refer to people's daily self-care activities such as bathing, grooming, ambulation, etc.). Review of an undated Resident Characteristic Roster (RCR) showed Resident 4 was identified as having incontinence and skin issues. Review of Hospice notes, dated 07/13/2023, showed Resident 4 had a stage two (a shallow, crater- like wound or a blister containing a clear or yellow fluid) pressure sore on her coccyx (tailbone). In interview, on 07/25/2026 at 12:00 PM, Staff F (Medication Technician) stated the Hospice Nurse (HN) managed Resident 4's wound dressing change. Staff F stated she would clean Resident 4's pressure sore only if it became soiled and then inform the HN. Review of Resident 4's SP, dated 07/07/2023, under the Skin Care Intervention section, showed no information regarding Resident 4's wound. There was no information as to who managed the dressing changes or instructions to ALF staff regarding what to monitor, precautions or who to contact with issues. RESIDENT 5 Review of a RI form showed the ALF admitted Resident 1 on /2023 with multiple medical diagnoses including . Statement of Deficiencies License #: 2426 Compliance Determination # 27086 Plan of Correction Mukilteo Memory Care Completion Date and Record showed Resident 5 started hospice care on 03/24/2023, that was later discontinued on 05/15/2023. Record showed Resident 5 required 4 liters per minute of oxygen (O2) that was started on 03/24/2023, that was discontinued on 05/15/2023. Review of Resident 5's SP, dated 07/07/2023, showed it had not been updated to address O2 treatment and hospice care had been discontinued. The NSA showed instructions related to O2 monitoring, observations and precautions. This is an uncorrected deficiency previously cited on 05/25/2023. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, Mukilteo Memory Care 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-2320 Intermittent nursing services systems. (2) The assisted living facility providing nursing services, either directly or indirectly, must ensure that the nursing services systems include: (b) Nurse delegation, if provided; (e) Implementation of the nursing component of each resident's negotiated service agreement; and (3) The assisted living facility must ensure that all nursing services, including nursing supervision, assessments, and delegation, are provided in accordance with applicable statutes and rules, including, but not limited to: (c) Chapter 246-840 WAC, Practical and registered nursing; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to follow the criteria for nurse delegation (ND) for 3 of 4 sampled residents (Residents 2, 3 and 6). This . Statement of Deficiencies License #: 2426 Compliance Determination # 27086 Plan of Correction Mukilteo Memory Care Completion Date resulted in unqualified staff members conducting nursing tasks without having the proper training and placed Resident 2, 3 and 6 at risk for compromised health conditions. Findings included… NOTE: The Nurse Delegation Program, under Washington State law, allowed nursing assistants (NAs) and Home Care Aides (HCAs) working in certain settings to perform certain tasks--such as administering medications--normally performed only by licensed nurses. A Registered Nurse (RN) must teach and supervise the nursing assistant, as well as provide nursing assessments of the patient's condition. NOTE: Washington Administrative Code (WAC) 246-840-930 Criteria for delegation, included the following subsections: (8) Verify that the nursing assistant or home care aide: (a) Is currently registered or certified as a nursing assistant or home care aide in Washington state without restriction; (b) Has completed both the basic caregiver training and core delegation training before performing any delegated task; (c) Has evidence as required by the department of social and health services of successful completion of nurse delegation core training; (d) Has evidence as required by the department of social and health services of successful completion of nurse delegation special focus on diabetes training when providing insulin injections to a diabetic client; (9) Assess the ability of the nursing assistant or home care aide to competently perform the delegated nursing task in the absence of direct or immediate nurse supervision. (10) If the registered nurse delegator determines delegation is appropriate, the nurse: (14) Delegation requires the registered nurse delegator teach the nursing assistant or home care aide how to perform the task, including return demonstration or other method of verification of competency as determined by the registered nurse delegator. (19) The registered nurse must supervise and evaluate the performance of the nursing assistant or home care aide with delegated insulin injection authority at least weekly for the first four weeks. After the first four weeks the supervision shall occur at least every 90 days. Review of the ALF's undated Disclosure of Services showed that the ALF used Nursing Assistants as Medication Technician (MT) under the Delegation of a Registered Nurse to provide some authorized nursing services, including administration of insulin injections.

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