Peters Creek Retirement Community.

Statement of Deficiencies License #: 2245 Compliance Determination # 64161 Plan of Correction PETERS CREEK RETIREMENT COMMUNITY 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 follow-up on 08/14/2025 of: PETERS CREEK RETIREMENT COMMUNITY 14431 REDMOND WAY REDMOND, WA 98052 This document references the following SOD dated: 08/15/2025 The following sample was selected for review during the unannounced on-site visit: 9 of 46 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Michelle Yip, ALF Licensor From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 . Statement of Deficiencies License #: 2245 Compliance Determination # 64161 Plan of Correction PETERS CREEK RETIREMENT COMMUNITY 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 388-112A-0611 Who in an assisted living facility is required to complete continuing education training each year, how many hours of continuing education are required, and when must they be completed? (1) The continuing education training requirements that apply to certain individuals working in assisted living facilities are described below. (a) The following long-term care workers must complete twelve hours of continuing education by their birthday each year: (iii) A certified nursing assistant; (2) A long-term care worker who does not complete continuing education as required under this chapter must not provide care until the required continuing education is completed. WAC 388-112A-0720 What are the CPR and first-aid training requirements? (2) Assisted living facilities. (a) Assisted living facility administrators who provide direct care and long-term care workers must have and maintain a valid CPR and first-aid card or certificate within thirty days of their date of hire. WAC 388-78A-2474 Training and home care aide certification requirements. (2) The assisted living facility must ensure all assisted living facility administrators, or their designees, and caregivers hired on or after January 7, 2012 meet the long-term care worker training requirements of chapter 388-112A WAC, including but not limited to: (d) Cardiopulmonary resuscitation and first aid; and (e) Continuing education. This requirement was not met as evidenced by: . Statement of Deficiencies License #: 2245 Compliance Determination # 64161 Plan of Correction PETERS CREEK RETIREMENT COMMUNITY Completion Date Based on interview and record review, the facility failed to ensure 3 of 3 sampled staff (Staff F, Staff X, and Staff Y) completed the continuing education (CE), as required. This failure placed all 46 residents at risk of receiving inadequate care from untrained staff. Findings included… Review of the Department's "Secure Tracking and Reporting Systems" (STARS) showed the Assisted Living Facility (ALF) received a citation for this regulation on 07/09/2025. The ALF signed an attestation statement that stated the facility would have the deficiency corrected by 08/12/2025. Review of the facility’s Resident Caregiver and Medication Caregiver job descriptions dated 02/01/2018, and the facility’s undated Resident Services Director job description showed that care staff provided direct personal care and supervision to the residents consistent with Washington State regulations. STAFF F Review of the facility’s undated employee list showed the facility hired Staff F, Medication Technician, on 03/14/2023. Review of the facility’s employee schedule showed Staff F worked at the facility to provide personal care to the residents between June 2025 and August 2025. Review of Staff F’s employee records showed Staff F held an active Nursing Assistant Certification (NAC). The records showed Staff F’s NAC was first issued on 09/01/2022. The records showed documentation that Staff F completed eleven hours of the required 12 hours of CE training, approved by the Department of Social and Health Services (DSHS), from their June 2024 birthday to their June 2025 birthday. STAFF X Review of the facility's undated employee list showed that the facility hired Staff X, Assisted Living Director, on 03/27/2018. Review of the facility’s employee schedule showed Staff X worked at the facility to provide personal care to the residents between June 2025 and August 2025. Review of Staff X’s employee records showed Staff X held an active Home Care Aide (HCA) certification. The records showed Staff X’s HCA certification was first issued on 07/05/2016. The records showed that as of 08/14/2025, Staff X completed six hours of the required 12 hours of CE training, approved by the DSHS, from their September 2023 birthday to their September 2024 birthday. STAFF Y Review of the facility's undated employee list showed that the facility hired Staff Y, Caregiver, on 10/30/2017. Review of the facility’s employee schedule showed Staff Y worked at the facility to provide personal care to the residents between June 2025 and . Statement of Deficiencies License #: 2245 Compliance Determination # 64161 Plan of Correction PETERS CREEK RETIREMENT COMMUNITY Completion Date August 2025. Review of Staff Y’s employee records showed Staff Y held an active NAC. The records showed Staff Y’s NAC was first issued on 01/17/2008. The records showed that as of 08/14/2025, Staff Y completed zero hours of the required 12 hours of CE training, approved by the DSHS, from their April 2024 birthday to their April 2025 birthday. During an interview on 08/14/2025 at 12:35 PM, Staff U, Executive Director, stated that they were unaware Staff F, Staff X, and Staff Y did not complete their 12 hours of continuing education training, as required. During an interview on 08/15/2025 at 10:30 AM, Staff U stated that they were unable to locate any additional training documentation of CE trainings for Staff F, Staff X, and Staff Y. This is an uncorrected deficiency previously cited on 07/09/2025, subsection (2)(e). 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, PETERS CREEK RETIREMENT COMMUNITY 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 . Statement of Deficiencies License #: 2245 Compliance Determination # 61848 Plan of Correction PETERS CREEK RETIREMENT COMMUNITY 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 246-215-02310 Hands and arms When to wash (FDA Food Code 2-301.14). foodemployees shall clean their hands and exposed portions of their arms as specified under WAC 246-215-02305 immediately before engaging in food preparation including working with exposed food, clean equipment and utensils, and unwrapped single-service and single-use articles and: (5) After handling soiled equipment or utensils; WAC 246-215-03510 Temperature and time control Thawing (FDA Food Code 3-501.13). Except as specified in subsection of this section, time/temperature control for safety food must be thawed: (5) reduced oxygen packaged fish that bears a label indicating that it is to be kept frozen until time of use must be removed from the reduced oxygen environment: (a) Prior to thawing under refrigeration as specified in subsection (1) of this section; or (b) Prior to, or immediately upon completion of, thawing using procedures specified in subsection (2) of this section. WAC 388-78A-2305 Food sanitation. The assisted living facility must: (1) Manage food, and maintain any on-site food service facilities in compliance with chapter 246-215 WAC, Food service; This requirement was not met as evidenced by: Based on observation, interview, and record review, the faciltiy failed to ensure staff followed proper food safety guidelines in 1 of 1 commercial kitchens (main kitchen). The facility failed to ensure 1 of 1 dishwasher staff (Staff J) followed proper hand sanitation guidelines. The facility failed to ensure 1 of 1 counter height two-drawer refrigerators (two-drawer frig 1) maintained food at a temperature of 41 degree Fahrenheit (F) or less.

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.