The Cottages of Renton.

Statement of Deficiencies License #: 2496 Compliance Determination # 65549 Plan of Correction The Cottages of Renton 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 09/12/2025 of: The Cottages of Renton 17033 108th Ave SE Renton, WA 98055 This document references the following SOD dated: 09/12/2025 The following sample was selected for review during the unannounced on-site visit: 7 of 50 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Michelle Yip, ALF Licensor Kathy Young, Licensor Jane Hermano, NCI Thomas Forkgen, ALF Licensor From: DSHS, Aging and Long-Term Support Administration 20425 72nd Avenue S, Suite 400 Kent, WA 98032 Statement of Deficiencies License #: 2496 Compliance Determination # 65549 Plan of Correction The Cottages of Renton 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 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 facility failed to ensure 1 of 1 kitchen staff (Staff P) followed hand sanitation guidelines in the main commercial kitchen. These failures placed all 50 residents at risk of food contamination, foodborne illness, and a diminished quality of life. 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 07/25/2025. The ALF signed an attestation statement that stated the facility would have the deficiency corrected by 09/05/2025. Statement of Deficiencies License #: 2496 Compliance Determination # 65549 Plan of Correction The Cottages of Renton Completion Date Review of the facility’s undated policy titled, “Hand Washing Protocol and Procedures” showed that dietary workers must wash their hands according to proper procedures stated by the Centers for Disease Control (CDC) and the State of Washington. Review of the facility document titled, “Training and Memo”, dated 08/26/2025, showed food employees must wash their hands for 20 – 40 seconds before touching clean equipment and utensils. Review showed Staff P, Cook Assistant, reviewed and signed the memo on 08/29/2025. Observation on 09/12/2025 at 12:44 PM, showed Staff P washed dirty dishes brought in from the resident cottages. Observation showed Staff P completed four-second handwashing. Observation showed that with bare hands, Staff P loaded paper towels in the dispenser, touched their face, unloaded and put away pans and utensils without washing their hands. Then Staff P completed six second handwashing, completed date labels, which they added to juice pitchers before putting the juice into the refrigerator. Observation showed Staff P then put away the clean dishes with bare hands. Observation showed Staff P touched their face and put on fresh gloves. Observation showed Staff P loaded dirty dishes. Observation showed Staff P removed their gloves, left the kitchen, and returned with clean cleaning cloths and oven mitts. Observation showed Staff P dropped a pair of single-use gloves on the floor and put them on the counter. Observation showed Staff P put on the single-use gloves previously retrieved from the floor. Observation showed Staff P used sanitizing solution on the carts. Observation showed Staff P completed 10-second handwashing. During an interview on 09/12/2025 at 1:17 PM, Staff P, stated that the procedure for handwashing was to wet their hands with “really” hot water, put some soap on them, and “scrub for a few seconds”. This is an uncorrected deficiency previously cited on 07/23/2025, for subsection (1). 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, The Cottages of Renton 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 #: 2496 Compliance Determination # 65549 Plan of Correction The Cottages of Renton Completion 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-1000 Which trainings require department approval of the curriculum and instructor? (1) Except for facility orientation training under WAC 388-112A-0200 (1), the department must preapprove the curriculum, including delivery mode, and instructors for all training required under this chapter. 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: (e) Continuing education. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure 3 of 5 sampled care staff (Staff E, Staff Q, and Staff R) completed the continuing education training, as required. This failure placed all 50 residents at risk for decreased quality of care provided by caregivers with incomplete training. 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 07/23/2025. The ALF signed an attestation statement that stated the facility would have the deficiency corrected by 09/05/2025. Review of the facility’s Assisted Living Facility Resident Characteristic Roster, dated 09/12/2025, showed that 50 residents received assisted living services. Review of the facility’s undated document titled, “Job Description-Medication Technician”, showed Medication Technicians provided personal care and supervision to Statement of Deficiencies License #: 2496 Compliance Determination # 65549 Plan of Correction The Cottages of Renton Completion Date the residents consistent with Washington State regulations. Review of the facility’s undated document titled, “Job Description-Nursing Assistant”, showed Nursing Assistants provided personal care to the residents consistent with Washington State regulations. STAFF E Review of the facility's Employee List, dated 09/12/2025, showed the facility hired Staff E, Medication Technician/Caregiver, on 04/03/2023. Review of the facility’s care staff schedule showed that on 09/10/2025, Staff E provided care and services to the residents. Review of Staff E’s employee records showed Staff E held an active Nursing Assistant Certification that was first issued on 10/13/2023. The records showed Staff E completed 11.25 hours of Continuing Education (CE), approved by the Department of Social and Health Services (DSHS), between their April 2024 and April 2025 birthdays, 0.75 hours short of the required 12 hours of CE training. STAFF Q Review of the facility's Employee List, dated 09/12/2025, showed the facility hired Staff Q, Medication Technician/Caregiver, on 03/05/2021. Review of the facility’s care staff schedule showed between 09/05/2025 and 09/12/2025, Staff Q provided care and services to the residents on six days. Review of Staff Q’s employee records showed Staff Q held an active Nursing Assistant Certification that was first issued on 09/25/2021. The records showed Staff Q completed one hour of CE, approved by the DSHS, between their September 2024 and September 2025 birthdays, 11 hours short of the required 12 hours of CE training.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: The Cottages of Renton Provider Type: Assisted Living Facility License/Cert.#: 2496 Intake ID: 166343 Compliance Determination #: 55044 Region/Unit #: RCS Region 2 / Unit D Investigator: Harrison Udoye Investigation Date(s): 02/19/2025 through 03/12/2025 Complainant Contact Date(s): 02/19/2025 Allegation(s): 1) Alleged neglect 2) Improper medication services. 3) Inappropriate actions by outside provider (Hospice) Investigation Methods: Sample: Total residents: 57 Resident sample size: 3 Closed records sample size: 0 Observations: Residents Resident care equipment Resident rooms Staff to resident interactions Resident to resident interactions Medication administration Interviews: Nursing staff Residents Family members Business office manager Therapy staff Staff development coordinator Record Reviews: Medical records Hospital records Incident investigation Facility policies Staff patterns Investigation Summary: 1) Report of alleged neglect in the memory care unit of the Assisted Living Facility (ALF). Interview and record review showed that Named Resident was dependent with all Activity of Daily Living (ADL's). Facility staff provided care and service to Named Resident. On 02/06/2025 at about 11:45 AM, facility staff found Named Resident . weak and unresponsive in their wheelchair. Facility staff immediately called 911 and was instructed by 911 operator to start lifesaving chest compression. Compressions started until staff located Named Resident's life saving orders. Facility staff failed to inform the 911 operator that Named Resident had a "Do Not Resuscitate" (DNR) order in place. Emergency Medical Team (EMT) arrived, noted a weak pulse, and transported Named Resident to the hospital without any chest compression. No abuse or neglect noted. Facility staff failed to follow their policy and procedure on the DNR order. Citation issued. 2) Allegation of overmedication in the memory care of the Assisted Living Facility. Interview and record review showed that Named Resident was in the facility locked unit due to severe cognitive impairment. Named Resident was dependent on facility staff for all ADLs and mobility. Facility staff do not prescribe or order medication for residents in their facility. Facility staff do notify Residents' Primary Care Providers (PCP) and their representatives for any change in condition. PCPs then decide if medical intervention were necessary. Facility staff followed medication orders given by PCPs. Facility staff followed their policy and procedures. No failed practice identified. Facility met their regulatory requirements. 3) Alleged unwelcome Hospice practices After interviews and record reviews, it was shown that the outside provider contracted with residents' representatives to provide care for residents in the facility. Hospice agency practices were out of licensing jurisdiction for the Residential Care Service (RCS) to investigate. 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 . resident interactions and resident to staff interactions. Based on interviews, record reviews and observations, facility did not comply with regulatory requirements and citation issued on intake numbers 153428, 1529882, 157865, 15473, 15851. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . citation issued on intake numbers 153428, 1529882, 157865, 15473, 15851. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . citation issued on intake numbers 153428, 1529882, 157865, 15473, 15851. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . citation issued on intake numbers 153428, 1529882, 157865, 15473, 15851. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Statement of Deficiencies License #: 2496 Compliance Determination # 49917 Plan of Correction The Cottages of Renton Completion Date Administrator (or Representative) Date WAC 388-78A-2100 Ongoing assessments. (2) The assisted living facility must: (b) Complete an assessment specifically focused on a resident's identified problems and related issues: (i) Consistent with the resident's change of condition as specified in WAC 388-78A-2120 ; (ii) When the resident's negotiated service agreement no longer addresses the resident's current needs and preferences; (iii) When the resident has an injury requiring the intervention of a practitioner. This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to update 2 of 2 residents (Resident 1 and Resident 2) service plans when there was a change of condition. This failure placed Resident 1 and Resident 2 at risk of a diminished quality of life due to unmet care needs. Findings included… RESIDENT 1 Review of facility policy titled, “Fall Prevention and Protocol”, dated 10/01/2020, showed all residents receive a fall assessment that is done with each annual assessment and after any subsequent falls. Review of facility policy titled, “Fall with a Potential Head Injury”, dated 11/01/2023, showed the facility would initiate a temporary service plan and resident care team would be notified of the change. Review of the facility’s characteristic roster showed the facility admitted Resident 1 in 2023. Observation on 10/23/2024 at 2:45 PM showed Resident 1 sat in a recliner, in the reclined position, in the common area of Cottage D. Observation showed no walker or wheelchair near Resident 1. . Statement of Deficiencies License #: 2496 Compliance Determination # 49917 Plan of Correction The Cottages of Renton Completion Date Review of department intakes showed from 08/23/2024 through 11/14/2024, Resident 1 had eight falls. Review of Resident 1’s records showed on /2024, Resident 1 slipped and fell into a pole as they returned to bed. Resident 1 sustained a hip fracture from the fall. The records showed Resident 1 had an unwitnessed fall that resulted in a head injury which required treatment at the hospital. Review of Resident 1’s records showed on /2024, Resident 1 had an unwitnessed fall which required hospitalization for treatment of five rib fractures. Review of facility incident report, dated /2024, showed Resident 1 had an unwitnessed fall. The report showed Resident 1 was found on the floor with a head injury. Resident 1 was sent to the hospital for treatment. Review of the facility incident report, dated /2024, showed Resident 1 had an unwitnessed fall. Resident 1 was found on the floor in the common area of Cottage D. The report showed Resident 1 fell as they transferred from a seated to a stand position and the walked away without staff assistance. Resident 1 sustained a head injury during the fall. Review of facility investigation records, dated 10/30/2024, showed Resident 1 had an unwitnessed, injury fall on /2024. Resident 1 sustained a punctured right lung from the fall. Resident 1 was sent to the hospital. Resident 1 developed sepsis (a life-threatening complication of an infection), hemorrhagic shock (shock caused by heavy blood loss), a kidney infection, and fractured their clavicle (collar bone) and eight ribs. Records showed Resident 1 discharged from hospital to skilled nursing facility and passed away on /2024. Review of Resident 1’s Service Plan, dated 01/31/2024, showed Resident 1 required staff reminders with dressing tasks and assistance with nail care. The plan, dated 07/31/2024, showed Resident 1 required maximum staff assistance with personal hygiene and was a fall risk when Resident 1 moved from a seated or laying position to a stand position. The plan, dated 09/05/2024, showed Resident 1 required maximum staff assistance with transfers. The service plan, dated 10/03/2024, showed Resident 1 required maximum staff assistance with bed and chair mobility and staff reminders to use their walker when ambulating. After hospitalizations in 2024, and upon Resident 1’s return to the facility in 2024, there were no service plan updates completed. Review of the hospital discharge notes, dated /2024, showed Resident 1 discharged from the hospital with a wheelchair. Review of the notes showed Resident 1 required assistance to propel wheelchair and increased supervision when walker was used. Review of hospital physical therapy (PT) discharge notes, dated /2024, showed Resident 1 required a wheelchair or front wheeled walker for mobility with 24-hour continuous staff . Statement of Deficiencies License #: 2496 Compliance Determination # 49917 Plan of Correction The Cottages of Renton Completion Date assistance. The hospital PT discharge notes showed Resident 1 required maximum staff assistance with upper and lower body dressing, and staff assistance with toileting, grooming, and bathing. Record review showed there was no documentation that the facility initiated their “Fall Prevention” policy related to Resident 1’s repeated falls. There was no documentation that showed the facility initiated their “Fall with Head Injury” policy. There was no updated service plan, no new assessment completed, and no documentation that showed staff were provided with a temporary service plan to follow related to Resident 1’s change of condition. During an interview on 10/16/2024 at 1:15 PM, Collateral Contact 1 (CC1- Resident 1 representative) stated that they were concerned about the excessive number of falls by Resident 1. CC1 stated that they never received any updated service plans from the facility staff to show what care plans were changed to try and prevent Resident 1 from falling. CC1 stated that they were concerned about the lack of supervision, monitoring, general resident oversight, and lack of service plan updates related to Resident 1’s change of condition with increased care needs. During an interview on 10/23/2024 at 1:30 PM, Staff A, Executive Director, stated that Resident 1 had multiple falls while at the facility. Staff A stated that most of the falls were when Resident 1 slipped out of bed to the floor. Staff A stated that the unwitnessed fall on /2024 was a result of Resident 1 slipping and hitting on the transfer pole at the bedside. Staff A stated that Resident 1 required staff assistance with transfers out of a chair or their bed. Staff A stated that Resident 1 did not always wait for staff to assist with transfers. Staff A stated that they planned to order a chair alarm to assist staff with alerts when Resident 1 attempted to transfer without staff assistance. During an interview on 10/23/2024 at 1:30 PM, Staff B, Director of Nursing, stated that on 10/10/2024, the physical therapist released Resident 1 from using a wheelchair and Resident 1 was discharged from any further physical therapy appointments. Staff B stated that Resident 1 was very unsteady on their feet. Staff B stated that Resident 1 was able to independently ambulate with a front wheeled walker. Staff B stated that Resident 1 required maximum assistance with transfers. Staff B stated that Resident 1’s service plan was updated to reflect the increased staff monitoring of Resident 1. During an interview on 10/23/2024 at 2:50 PM, Staff C, Caregiver, stated that Resident 1 was able to independently walk around the facility and to the bathroom with their walker. Staff C stated that Resident 1 frequently forgot to use their walker. During an interview on 12/18/2024 at 8:30 AM, Collateral Contact 4, (CC4- Resident 1’s Medical Provider), stated that Resident 1’s multiple falls with injury caused Resident 1 pain and suffering.

Statement of Deficiencies License #: 2496 Compliance Determination # 34657 Plan of Correction The Cottages of Renton 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 on 01/03/2024 and 01/09/2024 of: , The Cottages of Renton 17033 108th Ave SE Renton, WA 98055 The following sample was selected for review during the unannounced on-site visit: 9 of 56 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Thomas Forkgen, ALF Licensor Steven Garrett, LTC Licensor Jane Hermano, NCI From: DSHS, Aging and Long-Term Support Administration - 20425 72nd Avenue S, Suite 400 Kent, WA 98032 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. Law Sndliraonr 01/30/2024 | 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. ‘AUSQAM JO}EI07 BY} JO} SBd|ANaS ued jeljUapisay Aq pasedasd sem yUaINIOp siyL Statement of Deficiencies License #: 2496 Compliance Determination # 34657 Plan of Correction The Cottages of Renton Completion Date ‘ Admingstrator (or Representative) ate WAC 388-78A-2140 Negotiated service agreement contents. The assisted living facility must develop, and document in the resident's record, the agreed upon plan to address and support each resident's assessed capabilities, needs and preferences, including the following: (1) The care and services necessary to meet the resident's needs, including: (a) The plan to monitor the resident and address interventions for current risks to the resident's health and safety that were identified in one or more of the following: (i) The resident's preadmission assessment; (ii) The resident's full assessments; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to document a plan to monitor and address interventions required to meet the current clinical needs for 2 of 2 residents (Resident 7 and Resident 22). This failure placed the resident at risk for unmet care needs and potential harm. Resident 7 Review of the facility's move in record showed that the facility admitted Resident 7 on [2022 with multiple diagnoses which included with . Review of Resident 7’s October 2023, November 2023, December 2023, and January 2024 electronic medication administration record (eMAR) showed the resident received administration assistance with medication management that included an anti-seizure medication Lacosamide 100 milligrams (mg), by mouth, two times a day. Review of the Resident 7’s assessment, dated 10/04/2023, showed Resident 7 had history of seizures. Review of Resident 7’s service plan, dated 06/16/2023, did not document the signs and symptoms of seizures. The service plan provided no staff instructions to follow if Resident 7 experienced a seizure, Interview on 01/05/2024 at 1:59 PM, Staff B, Director of Nursing (DON), stated that the staff were trained to call the Medication Technician when a resident has a seizure episode, Staff B stated the facility did not have a seizure protocol. Staff B was aware Resident 7’s service pian had no’seizure interventions or safety plan written on it. Interview on 01/08/2024 at 8:55 AM, Staff U and Staff X did not Know that Resident 7 had ‘AUSQAM JO}EIO7 BY} JO} SBd|ANaS ued jelJUapIsay Aq pasedasd sem yUaWNIOp si, Statement of Deficiencies License #: 2496 Compliance Determination # 34657 Plan of Correction The Cottages of Renton Completion Date a seizure disorder, Staff U and Staff X stated they were instructed by nursing to call the Medication Technician in the case that any resident had a seizure. Resident 22 Review of the facility's move in record showed that the facility admitted Resident 22 on 2020 with multiple diagnoses including : Review of Resident 22’s December 2023 and January 2024 eMAR showed Resident 22 receive convulsion medication Levetiracetam 500 mg, to give 0.5 tablet, by mouth, two times a day. Review of the Resident 22’s undated service plan did not document the signs and symptoms of convulsions. The service plan provided no staff instructions or a safety plan to implement if Resident 22 experienced convulsions, Interview on 01/09/2024 at 10:39 AM, Staff B stated that Resident 22 had a history of convulsion. Staff B stated that they were aware Resident 22’s service plan had no convulsion interventions or safety plan written on it. Plan/Attestation Statement | hereby certify that | have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, The Cottages of Renton is or will be in compliance with this law and / or regulation on (Date) 3/te/ ZOOL ay 14 : In addition, | will implement a system to monitor and ensure continued compliance with this requirement. Fin depart &SL/ Us! [zo2¥ Administrator @r Representative) ! Date WAC 388-78A-2610 Infection control. (1) The assisted living facility must institute appropriate infection control practices in the assisted living facility to prevent and limit the spread of infections, This requirement was not met as evidenced by: Based on observation, interview and record review, 1 of 1 staff (Staff J) failed to implement infection control practices related to proper hand washing hygiene when providing medication administration assistance to 56 of 56 residents (Resident 1 to Resident 56). This failure placed all 56 residents at risk of illness from possible infections and a decreased quality of life due to potential medical emergency from possible cross contamination of medications. ‘AUSQAM JO}EIO7 BY} JO} SBd|ANaS ued jelJUapIsay Aq pasedasd sem yUaINIOp siyL Statement of Deficiencies License #: 2496 Compliance Determination # 34657 Plan of Correction The Cottages of Renton Completion Date Findings included... The Centers for Disease Control and Prevention (CDC) developed guidelines for infection prevention and control practices for healthcare settings. Review of CDC's "Health Care Providers: Hand Hygiene", showed that hand hygiene reduced the incidents of infections. Review of the facility's policy titled, "Infection Control’, revised 03/28/2023, showed the importance of handwashing and required new employees complete an in-service training for hand washing and universal precautions. The policy showed employee hands should be washed before and after touching a resident. Review of the facility’s policy titled, ‘Delegation of Nursing Tasks”, revised 04/01/2021, showed step- by-step instructions for the administration of medications. The instructions included hand washing before and after staff provided medication administration assistance for the residents. During an interview on 01/03/2023 at 9:15 AM, Staff A, Executive Director, stated that there were three memory care cottages on the campus. Staff A stated that all residents were diagnosed with Or I . Staff A stated that staff provided medication assistance or administration services to all residents. BIRCH COTTAGE Observation in the common dining area on 01/04/2024 between 7:45 AM and 8:36 AM showed Staff J, Medication Technician/Caregiver, administered medications to Resident 15, Resident 16, Resident 18, Resident 19, and Resident 20. Between each resident medication assistance, Staff J used their bare hands to handle the keys to lock and unlock the medication cart and retrieved the medication cards that contained the residents’ medications in unit-of-use packaging. Observation showed Staff J pushed out each medication from the cards into plastic medication cups. After each resident medication administration assistance provided, Staff J touched the laptop and documented the activity in the electronic medication administration record (eMAR) system. Observation showed that Staff J did not wash their hands or use hand sanitizer before or after they provided each resident with medication administration assistance. Observation on 01/04/2024 at 8:29 AM showed Staff J pulled out a lidocaine transdermal patch (medication for pain) from the medication cart. Staff J put on gloves and removed the patch’s protective liner. Observation showed Staff J approached Resident 19, raised their shirt, and applied the patch to their lower back. Observation showed Staff J removed their gloves and washed their ‘hands, Observation showed that Staff J did not sanitize or wash their hands before they applied the patch. CEDAR COTTAGE ‘AUSGAM J0}EI07 BY} JO} SAd|ANaS ued jeljUapIsay Aq pasedasd sem yUaWNIOp siyL Statement of Deficiencies License #: 2496 Compliance Determination # 34657 Plan of Correction The Cottages of Renton Completion Date Observation in common dining/living room areas and residents’ apartments on 01/04/2024 between 8:48 AM and 10:00 AM showed Staff J assisted and administered medications to 17 unidentified residents.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20425 72nd Avenue S, Suite 400, Kent, WA 98032 Renton Special Care Community LLC The Cottages of Renton 17033 108th Ave SE Renton, WA 98055 RE: The Cottages of Renton License # 2496 Dear Administrator: This letter addresses Compliance Determination(s) 33279 (Completion Date 11/29/2023) and 27856 (Completion Date 10/04/2023). The Department completed a follow-up inspection of your Assisted Living Facility on 11/29/2023 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-2180-1-b The Department staff who did the on-site verification: Karri Hernandez, Community Complaint Investigator If you have any questions, please contact me at (253)234-6020. Sincerely, Laurie Anderson, Field Manager Region 2, Unit D . . . . . . . . .