Sun Terrace Prosser.

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

Citation(s) Written Failed Provider Practice Not Identified / No Citation Written □ N/A □ . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALT H SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Licensee CLAY DAVIS STROUD LLC SUN TERRACE PROSSER 2131 WINE COUNTRY ROAD PROSSER, WA 99350 RE SUN TERRACE PROSSER License# 1440 Dear Administrator: The Department completed a full inspection and a complaint investigation of your Assisted Living Facility on 07/22/2024 and found that your facility does not meet the Assisted Living Facility licensing requirements. The Department • Wrote the enclosed Statement of Deficiencies (SOD) report; and •May take licensing enforcement action based on any deficiency listed on the enclosed report; and •May inspect the facility to determine if you have corrected all deficiencies. You Must: • Begin the process of correcting the deficiency or deficiencies immediately; • Contact the Field Manager for clarifications related to the Statement of Deficiencies (SOD); • Within 10 calendar days after you receive this letter, complete and return the enclosed 'Plan/Attestation Statement'; o Sign and date the enclosed report; o For each deficiency, indicate the date you have or will correct each deficiency; o Next to each deficiency, sign and date certifying that you have or will correct each cited deficiency; and o Mail the Plan/Attestation Statement and report with original signatures to: . CLAY DAVIS STROUD LLC SUN TERRACE PROSSER # 1440 07{22{2024 Michelle Closner, Field Manager Region 1, Unit G 1200 Alder Street Union Gap, WA 98903 • Complete correction(s) within 45 days, or sooner if directed by the Department, after review of your proIposed correction dates. • Have your plan approved by the Department. You May: • Receive a letter of enforcement action based on any deficiency listed on the enclosed report. In Addition, You May: • Request an Inform al 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: I DR Program Manager Department of Social and Health Services POBox45600 Olympia, WA 98504-5600 If You Have Any Questions: • Please contact me at (509)572-7394. Sincerely, {¼.uuvi, ~ Michelle Closner, Field Manager Region 1, Unit G Enclosure . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Stateme11t of Def1c1enc1es License# 1440 Compliance Determination # 44345 Plan of Correction SUN TERRACE PROSSER 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 the unannounced on-site full inspection and complaint investigation on 07/15/2024, 07/16/2024, 07/17/2024 and 07/18/2024 ot SUN TEIRRACE PROSSER 2131 WINE COUNTRY ROAD PROSSER, WA 99350 This document references the following complaint numbers: 138361. The following sample was selected for review during the unannounced on-site visit: 10 of 64 current residents and O former residents. The department staff that inspected the Assisted Living Facility: Anna Cairns, ALF Long Term Care SuNeyor Jessica Clapp, Assisted living Facility licensor Robin Rainville, Assisted Living Facility Licensor Tracy Ramirez, Assisted living Facility licensor From: DSHS, Aging and Long-Term Support Administration Residential Care SeNices, Region 1 , Unit G 1200 Alder Street Union Gap, WA 98903 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. C/44JUA, ~ 07/25/2024 Residential Care SeNices Date . 07.26.2024 10:50:19 State of Washington 6/24 Sttt~n,ie~t of Ddidi\ndes; Li;;~•~,$,€ #'. 'l 44:Ci Comp-1:i.int~ DBfothliii;3;i!Hi # 443 43 Pl~1r1 of C oit•~diors SUN TERRi~G!: f:iROSSt:~ Ct.,mpl-€fain Date Pa,g~ 4 of 14 l understand thaH:J rnaintain an .t~ssisted Uving Facmtv ne.ense, t~te fadli~v' must t1e in campiiancl'i witt, an tw lk:ensin~J l:<Wii:S ~M regulations at"~/! t1rnes. /zq /202--':/ 7 WAC 388-78A-2160 implementation of negotiated service agreement. The assisted IMn:g facility must provide the .care and serviee.s as agreed upon in the negotiated service agreement to each resident unfess a deviation from the nego-ti.tted service agreement is mutually agre1,d upon between the assisted living fa~Uity and the resident or the resident's representative :at tht! tim=e the c:are or services are "Scheduled. This require:ment was not met as eviden<:ed by: 8;,~sed tm intervrnvi.i-..m d re.cord rnvl::.,•\•, the AssistM Uvit:!J FacJity {Alf) failed t,'} follcitdh~ laundry servkes at;reed up::m 1n the resident's n;;gctiated strvice i:liFeernent for 1 of 3 residents {Res,ident 2L who did nGt re.quire laundry assistance h:im the ALF. This faHme rem ..i ited in inc:feased laundry se~l~!:e. f~es an.ct unniet care n~e-ds. Rtvie,N of Rc,sident Xs 1,iegotiated Setvke Agreement (NSA) dated Ct\'27/2024 .• shuV'i~d the resident's fornily rnw1J:9ed tht reski~nh1 person~l laum:ky. In .m intervievv mi O?II tr2024 Jt 9:49 ;~M, Collateral Contact 1 (CC!)_R esident Reprnsentativf.,,. wit~t~ th.1t th€y \•Vere resp::.m~.it.Je for Resid,-:;nt 2t, laundty. CC'l stated that t.!1e stwf were tiware th€ farrdy pld·:ed Jp tne laun(in/ tv~•c times £1 week. C-C1 stated tl'latth~ ALF i1ad ~·v,:.istied Resident l's per.-s{ma! lauridr)' an multiple no:.asions. CC 1 further stated that they· k,fd the staff to stap doing Resident 2's iaundr)" ~1nd the: A.LF had contir,u:ed tG clo so, \••kiich resulted in additional d1arges. In an li1tetv\Bvv en 07ti B/2024 at 9A9 Arv1, Staff .A, .A.drninistrator, ;:ic.:knowledged th tit staff h-ad don~ Resident 2's pe.rsanal lm ..m diy ~md drnr1Je-:l tor the £H,rvic:e. Plan/Attestation Statement . Statement of Deficiencies License#: 1440 Compliance Determination #44345 Plan of Correction SUN TERRACE PROSSER Completion 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-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 follow the laundry services agreed upon in the resident's negotiated service agreement for 1 of 3 residents (Resident 2), who did not require laundry assistance from the ALF. This failure resulted in increased laundry service fees and unmet care needs. Findings included .. Review of Resident 2's Negotiated Service Agreement (NSA), dated 03/27/2024, showed the resident's family managed the resident's personal laundry. In an interview on 07/17/2024 at 9:49 AM, Collateral Contact 1 (CC1 ), Resident Representative, stated that they were responsible for Resident 2's laundry. CC1 stated that the staff were aware the family picked up the laundry two times a week. CC1 stated that the ALF had washed Resident 2's personal laundry on multiple occasions. CC1 further stated that they told the staff to stop doing Residenlt 2's laundry and the ALF had continued to do so, which resulted in additional charges. In an interview on 07/18/2024 at 9:49 AM, Staff A, Administrator, acknowledged that staff had done Residenlt 2's personal laundry and charged for the service. Plan/Attestation Statement . 07.26.2024 10:50:19 State of Washington 7/24 Stt~t~trient of Defid~nciei: u~etse #: ·144:Q Curr~pUt1nc~ Det~trnlttai~t-ri #443-~5 Pi~1n of C ott•2.dit1ri SUN lt:Rt)/;,CE. ~ROSSER C~mpi.a-hcn O. ;te Pa~;,5~1fl4 Gti2.1l20.24 I hBrnhy ::ertif\· mat I twve 1·eviH\•ed this rtpott and !1:,r1/e t~ken 0r V\if/1 ttike active 11,e.ttSLff"f::~t> t12~ ,,:~orre.r:t this defic;~rL>.::)t. By ta~·dn:;J t~~~s ·artion .. SUt',i T;:.<-·i•Rfa. . {~E Rt)!SSE ' - ~~ d '»f or ~vm be in ::or·npfo:mct· v~iith this la~·v and l or re1ulatk:n 0n {Datt .·.• -.-~~~----~""'.__ _ -'d-· In ,,td:diti,,m, I V'lm irnpl:ementa systern to ,nonitor an:d ensute <:'.ontinued cornphmce with ~ WAC 388-18A·2610 tnfection control. ( c) Pr•}""'id~ st-arr persJns ,\~th the nB\::essmy s,uppht£, t!quipr:r,ent and prntectivi:; ~~htl1in9 for prev,~ntnJ ,;m::l contnJ!Hng the spread af infections: This requirement wa.s not met as evidenced by: Ba5ed en int1€ -vie1'\I' and rect.rd revievv. tt,e .~ssi£,ted Uvtn:} Fad!ity {i~LF) failed tc pr~Jv1de sti:rff witt: gloves nH::ess.,ffy for pn::ivic.frtig resident 1:are for 2 ol' 4 residents {Residents .