Northcare Pasco.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . I&] □ □ STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Statement of Deficiencies License #: 2666 Compliance Determination # 69280 Plan of Correction NorthCare Pasco Completion Date You are required to be in compliance at all times with all licensing laws and regulations to maintain your Assisted Living Facility license. The department completed data collection for an unannounced on-site complaint investigation on 11/26/2025 of: NorthCare Pasco 5921 Road 60 Pasco, WA 99301 This document references the following complaint number(s): 202515 The following sample was selected for review during the unannounced on-site visit: 0 of 60 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Jessica Clapp, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration 1200 Alder Street Union Gap, WA 98903 . 12/09/2025 . Statement of Deficiencies License#. 666 Compliance De ermination #692 0 Plan of Correction o hC are Pasco Completion Date Page of 3 Licensee: NorthCare ashington LLC 12/03(20 5 As a re su It of th o -si vis it( s) , th d p rtm t faun t at you a r no in co p II a ce it lie nsin la s an r gula ons as st ed in e ci ed def1ci n i s in th los d r port. D in WAC 388-78A-2040 Other requirements. ( ) T ssisted livin acility st h v i s uildin a rove y th shington s at fi arsh I in or r to b II nsed. This requirement was not met as evildenced by: Ba • • d to • • mp Ii ith th atrol Fire Pr e the t Fir h I fou via • o s s during the I o o / 0 5 an to viol c un g t ion 10/ 1lur c d re in e cilr visitors a risk of ha nt o Find1 gs I cl ed ... o Ie the tat Patrol Fire Prot r port, date 5, d fail d th Ir I itial ins allow-up 10/ e d th e facility c lat the foll o ing • x roo shad ma tic hol rs at ere not onne ted to th far system. • U prov1d do um n ation comp! t . In an mt rvie o 11 / 6/ 0 5 : 9 PM, t A, o ed Fir M rs al po a d s ted tha a appeal ha at Statement of Deficiencies License #: 2666 Compliance Determination # 69280 Plan of Correction NorthCare Pasco Completion Date As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. Administrator (or Representative) Date WAC 388-78A-2040 Other requirements. (2) The assisted living facility must have its building approved by the Washington state fire marshal in order to be licensed. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to maintain compliance with the Washington State Patrol Fire Protection Bureau when the Deputy State Fire Marshal found the facility in violation of several codes during the initial inspection on 08/27/2025 and then continued to be in violation of two codes during the reinspection on 10/08/2025. This failure placed residents living in the facility, staff and visitors at risk of harm in the event of a fire. Findings included… Record review of the Washington State Patrol Fire Protection Bureau report, dated 08/27/2025, showed that the facility failed their initial inspection. The follow-up inspection, dated 10/08/2025, showed that the facility continued to violate the following requirements: • Six rooms had magnetic holders holding doors open that were not connected to the fire system. • Unable to provide documentation that a sensitivity test had been completed. In an interview on 11/26/2025 at 2:29 PM, Staff A, Registered Nurse, acknowledged the Fire Marshal Report and stated that an appeal had been completed. Review of a fire marshal electronic message dated 12/02/2025 at 9:28 AM, showed that . . ti:C.VC.IVt:.U ll./V':j/t:.Vl...J VV,'t:JI I~! 12.09.202.5 14:45:07 State of llash in gton 7/8 Sfatement cl De!ic,~nci•~ Uc~~~~ It 26l'l6. Compfrancs, Dedei''itlinatiGin #6:S200 Pfan~ o{ C.orte-ction Ni!JtthC::11·g Pase,;; Cornp!..,tfo,n Dabe f:::>~s~ 3 oi:., l 2.,0~IW•'.26 Plan ttestatlon St11tement I' her"tw te!'tify that I have re•Jiewesl tlli~ repmt ~nd 11av~ !eken nt wil: t~kf active measure"S to C:O~fH€ ".,'t ttWS, .i:;h;},tkie\'l•~:Y, Sy taXirtg thls actlor;rrcaJe pn~CrJ is or '1'1/;ll b!::;: in ~umplianGe with lllls )W/1! and I ar reg,,iafor; (H1 (D,ite) <.,, / :;)...0 . h-i ~ddltiu.1, I V1i!1I ~mpl<_;}rnitnf ~ ~ysttm to m,1JnibJr &ncl enm1re ·c.cn~nuBd c~m1pH~nc~ ,..-~it~ this re~wir~ment. O,,te, Statement of Deficiencies License #: 2666 Compliance Determination # 69280 Plan of Correction NorthCare Pasco Completion Date the appeal process had been completed and that the citations were upheld. In an interview on 12/03/2025 at 10:22 AM, Staff A acknowledged the appeal determination. 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, NorthCare Pasco 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 .

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 NorthCare Washington LLC NorthCare Pasco 5921 Road 60 Pasco, WA 99301 RE: NorthCare Pasco # 2666 Dear Administrator: This letter addresses deficiencies occurring in Compliance Determination 69480 (Completion Date 12/11/2025), which includes intake number(s) 202238. The Department completed a full inspection and a complaint investigation of your Assisted Living Facility on 12/11/2025 and found no deficiencies. The Department staff who did the inspection: Robin Barnes, Assisted Living Facility Licensor Jessica Clapp, Assisted Living Facility Licensor Tracy Ramirez, Assisted Living Facility Licensor If you have any questions, please contact me at (509)208-5231. Sincerely, Laura Ubbeams-Daves Laura Williams-Davis, ALF Field Manager Region 1, Unit G ‘BUSGAM J0}L907 BU} JOJ SadIAaS aseD jeljUapIsay Aq pasedaid sem yUuaWNIOp SIU)

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