Brookdale Torbett.

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 . Ii □ □ . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Statement of Deficiencies License #: 2325 Compliance Determination # 52160 Plan of Correction Brookdale Torbett 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 12/30/2024 of: Brookdale Torbett 221 Torbett St Richland, WA 99354 This document references the following complaint number(s): 159479, 160785 The following sample was selected for review during the unannounced on-site visit: 6 of 45 current residents and O former residents. The department staff that investigated the Assisted Living Facility: Elizabeth Hall, AFH/ALF Licensor Robin Rainville, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration 1200 Alder Street Union Gap, WA 98903 . Fei. 6. 2025 3:56PM No. 6583 P. 3 .30.2025 12:03:05 St,1te of Uash i ngton 6, Statement of Deficlencic;s Lkoen~e #:. 2325·-··· · Oornpl1ar100 Detern·,ination # 52i°60 Plan of Correction Brookdale Torbetl Completion Date Page 2 ot B Licensee: EMERITVS CORPORATION 0'1121/2025 As a resl1lt of the on-site visit(s), the department found that you are not in compliance with the licensing laws ,md regulations as stated in the cited deficiencies in the enclosed report ~ W V ~~ 01/30/2025 ~'l4,r I undersiaiid that tci .. maintain a·n Assisted Living Facility license. the facility must be in compliance with all the licensing laws and regulations at all times. ~:lN IYJJY\CS\C{n>Ji2.£11(2 0Admirnstrator (or Repl'esentative) ' WAC 388-7BA•2610 Infection control. (1) The assisted living facility must institute appropriate Infection control practices in the assisted living facility to prevent and limit ths spread of infections. (2) The assisted living facility must: (a) Develop and implement a system to identify and manage infections; (b) Restrict a staff person's contact with residents when the staff person has a known communicable disease in the infectious stage that is likely to be spread in the assisted living facility setting or by casual contact: (c) Provide staff persons with the necessary supplies, equipment and protective clothing for preventing and controlling the spread of Infections: (d) Provide all resident care and services according to current acceptable standards for infection control: (e) Perform all housekeeping, cleaning, laundry, and management of infectious waste according to current acceptable standards far infection control: This requirement was not met as evidenced by: Based on observation, interview and record review, the facility failed to implement and manage appropriate infection control practices and to provide the necessary supplie, to cme for residents, for 6 of 6 residents (Residents 1, 2, 3, 4, 5 and 6), Additio11ally, the facility failed to provide staff with the necessary training and protection needed to prevent t1·1e spread ol' infections for 7 of 9 staff (Slaff B, F. G. H, I, J, and K). These failures contributed to the spread of two infectious diseases throughout the facility and placed the residents at risk of complications of the illnesses and a decreased quality of life. 01/30/2025 . Statement of Deficiencies License #: 2325 Compliance Determination # 52160 Plan of Correction Brookdale Torbett 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-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. (2) The assisted living facility must: (a) Develop and implement a system to identify and manage infections; (b) Restrict a staff person's contact with residents when the staff person has a known communicable disease in the infectious stage that is likely to be spread in the assisted living facility setting or by casual contact; (c) Provide staff persons with the necessary supplies, equipment and protective clothing for preventing and controlling the spread of infections; (d) Provide all resident care and services according to current acceptable standards for infection control; (e) Perform all housekeeping, cleaning, laundry, and management of infectious waste according to current acceptable standards for infection control; This requirement was not met as evidenced by: Based on observation, interview and record review, the facility failed to implement and manage appropriate infection control practices and to provide the necessary supplies to care for residents, for 6 of 6 residents (Residents 1, 2, 3, 4, 5 and 6). Additionally, the facility failed to provide staff with the necessary training and protection needed to prevent the spread of infections for 7 of 9 staff (Staff B, F, G, H, I, J, and K). These failures contributed to the spread of two infectious diseases throughout the facility and placed the residents at risk of complications of the illnesses and a decreased quality of life. . Statement of Deficiencies License #: 2325 Compliance Determination # 52160 Plan of Correction Brookdale Torbett Completion Date Findings included ... Review of a facility policy titled, "Communicable Disease Control," dated 04/2024, showed that if an outbreak of a communicable disease occurred within the facility, staff were to adhere to standard precautions and the use of Personal Protective Equipment (PPE- gloves, gowns, masks, etc). The policy showed that standard precautions would be exercised during resident care, including the handling of any personal resident items. Review of an additional facility policy titled, "PPE Use Policy," dated 11/2022, showed that in the case of a norovirus (the virus that is the most common cause of stomach Infection, characterized by non-bloody diarrhea, vomiting, stomach pain, fever and/or headaches) outbreak, staff were to use contact based precautions which would include the use of gowns, masks, face shields, and gloves, when caring for symptomatic residents. The policy showed that in the event of respiratory illness outbreaks including COVID-19, n95 respirator masks (special protective masks that filter out harmful substances and require training and testing to ensure proper fit and protection for the wearer) were required to be used when caring for symptomatic residents. Review of the facility's norovirus tracking list, titled, "GI [Gastrointestinal] Line List," showed that between 12/22/2024 and 01/08/2025, a total of 24 residents and 15 staff had developed norovirus symptoms. The list showed that two staff members presented the first cases of symptoms, then the resident symptoms started on 12/24/2024 with 13 cases. The list showed that Residents 1, 2, 3, 4, 5 and 6 were included in the list as having had norovirus symptoms. Resident 1 Review of the facility's norovirus symptom tracking sheet showed that Resident 1 developed the norovirus symptoms on 12/28/2024, which resolved on 12/29/2024. Review of a Temporary Service Plan (TSP) in Resident 1' s record, dated 01/09/2024, showed that the resident was positive for COVID-19. Resident 1's progress notes, dated 12/13/2024 through 01/10/2025, did not show documentation regarding the resident's norovirus symptoms. Resident 1' s progress notes, dated 01/10/2025, showed that the resident was on alert charting due to testing positive for COVID-19. Resident 2 Review of the facility's norovirus symptom tracking sheet showed that Resident 2 developed the virus symptoms on 12/24/2025. . Statement of Deficiencies License #: 2325 Compliance Determination # 52160 Plan of Correction Brookdale Torbett Completion Date Review of progress notes in Resident 2's record, dated 12/24/2024 through 12/30/2024, showed that the resident had been monitored for viral symptoms of nausea, vomiting and diarrhea. Review of a TSP in Resident 2' s record, dated 12/30/2024, showed that the resident had new orders for medications to reduce vomiting and diarrhea. Resident 3 Review of the facility's norovirus symptom tracking sheet showed that Resident 3 developed the norovirus symptoms on 12/24/2025, which resolved on 12/28/2024. Review of progress notes in Resident 3's record, dated 12/27/2024, showed that the resident had medication changes due to having diarrhea that had started on 12/24/2024. Resident 4 Review of the facility's norovirus symptom tracking sheet showed that Resident 4 developed the virus symptoms on 12/24/2025. The tracking sheet showed that Resident 4 had a confirmed diagnosis of .

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 98:903 Statement of Deficiencies License#: 2325 Compliance Determination# 51622 Plan of Correction Brookdale Torbett Completion Date You are required to be in compliance at all times with all licensin~~ 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 12/09/2024, 12/10/2024, 12/11/2024, 12/12/2024 and 12/13/2024 of: Brookdale Torbett 221 Torbett St Richland, WA 99354 This document references the following complaint numbers: 155445. The following sample was selected for review during the unannounced on-site visit: 7 of 45 current residents and O former residents. The department staff that inspected the Assisted Living Facility: Elizabeth Hall, AFH/ALF Licensor Elaine Lopez, Licensor Robin Rainville, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration 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. 12/24/2024 . Statement of Deficiencies-- - - --License#: 2325 , ---, ComplianceDeterminatioflc#S-1622----~-- Plan of Correction Brookdale Torbett 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. I Date WAC 388-78A-2371 Investigations. The assisted living facility must: (1) Investigate and document investigative actions and findings for any alleged or suspected abuse, neglect, or financial exploitation; or accident or incident Jeopardizing or affecting a resident health or life; (2) Determine the circumstances of the event; (3) When necessary, institute and document appropriate measures to prevent similar future situations if the alleged incident Is substantiated; and This requirement was not met as evidenced by: Based on interview and record review, the facility failed to investigate and document investigative actions, and institute fall preventative measures for 4 of 4 residents (Resident 1 2, 5 and 7). These failures placed residents at risk of further Injuries or falls. Findings included ... Review of the facility's policy, "Incident Reporting Policy," revised 01/2024, showed that the facility staff member was to complete the preliminary notes of an incident or enter the incident into the facility's incident reporting system. The policy showed that a management member should review and lock the Incident no later than three business days after the data Is entered. In an interview on 12111/2024 at 10:58 AM, Staff J stated that the facility should have investigations for falls and altercations. <Resident 1> Review of Resident 1's demographic page, undated, showed that the resident moved into the facility on /2024. The demographic page also showed Resident 1 had a diagnosis of . Resident 1' s record included a temporary service plan (TSP), dated 11/22/2024, that showed the resident had been sent out to the hospital for evaluation of the injury to . -----Statement of Deficiencies - License#: 2325 Compliance Determination# 51622 Plan of Correction Brookdale Torbett Completion Date Page 3 of29 Licensee: EMERITUS CORPORATION 12/2312024 -----~--.·-~-----~ .._ , -~e•-"- c,s~----~-~ their head and had a 1.S..inch laceration. The record did not show an investigation for the 11/22/2024 incident had been completed. Review of Resident 1 's progress note, dated 11/23/2024, showed the resident had returned from the hospital at 04:39 AM, due ta a fall with a laceration to their scalp. In an interview an 12/10/2024 at 11:30 AM, Staff J, Licensed Practice Nurse/Area Regional Nurse, stated that they were unable ta find an investigation for Resident 1's fall that occurred on 11/22/2024. Resident 1's record included a TSP, dated 11/27/2024 which showed that the resident displayed physical aggression towards staff and family. The TSP showed that the facility called the local fire department far the resident to be sent ta the hospital. The record did not shaw that an investigation for the 11/2712024 incident had been completed. Resident 1's record included a TSP, dated 11/2912024 which showed that Resident 1 got into a physical altercation with another resident. The record did not show that an Investigation for the 11/29/2024 incident had been completed. In an interview on 12/11/2024 at 2:05 PM, Staff J, stated that they were not able to find investigations for the 11/27/2024 and 11/29/2024 incidents involving Resident 1. <Resident 2> Review of Resident 2's demographic page, undated, showed that the resident moved into the facility on /2024. The demographics page also showed that Resident 2 had a diagnosis of Review of Resident 2's 11/20/2024 TSP showed that the resident was being, "inappropriate," with residents and staff. The TSP showed that staff were to monitor and redirect the resident. Resident 2's record did not show that an investigation for the 11/20/2024 incident had been completed. Review of Resident 2's 11/29/2024 TSP showed that Resident 2 got into a physical altercation with another resident. The TSP showed that staff were to monitor and redirect the resident. Resident 2's record did not show that an investigation for the 11/29/2024 incident had been completed. In an interview on 12/11/2024 at 3:00 PM, Staff J, stated that they could not find the 11/20/2024 and 11129/2024 incident investigations for Resident 2. . -Statementof,Deficiencies- ------ --- License#: 2325 -Compliance Determination # 51622- , -- Plan of Correction Brookdale Torbett Completion Date Page 4 of29 Licensee: EMERITUS CORPORATION 12/23/2024 <Resident 5> Review of Resident S's demographics page, undated, showed that the resident moved into the facility on /2023. The page also showed that Resident 5 had a diagnosis of and . Review of Resident S's TSP dated 10/12/2024, showed that the resident had a fall with multiple skin tears. The TSP further stated, "Interventions indicated by investigation," with no interventions listed. Review of Resident S's progress note, dated 11/03/2024, showed that the resident was physically aggressive towards staff and three other residents. Review of Resident S's TSP, dated 11/09/2024, showed that the resident had hit another resident in the head. Review of Resident S's TSP, dated 11/17/2024, showed that the resident had a fall in their room. The TSP did not show any interventions to prevent further falls. Review of Resident S's TSP, dated 11/21/2024, showed that the resident had a fall with a skin tear to their middle finger. The TSP did not show any fall interventions. Review of Resident S's progress note, dated 11/26/2024, showed that the resident had returned from the hospital at 4:34 AM, due to receiving a cut to their scalp. Resident S's record included a TSP, dated 11/26/2024, which showed that the resident had been sent out to the hospital for evaluation after a fall with injury to their head and had received staples to close the wound. Review of Resident S's record showed that it did not include investigations and interventions for their four fall incidents and two altercations. In an interview on 12/11/2024 at 2:09 PM, Staff J stated that they were unable to find any further documentation regarding Resident S's incidents dated 10/12/2024, 11/03/2024, 11/09/2024, 11/17/2024, 11/21/2024, or 11/26/2024. <Resident 7> Review of Resident 7's demographics page, undated, showed that the resident moved into the facility on /2024. The page also showed that Resident 7 had a diagnosis of . . Statement of Deficiencies License #: 2325 Compliance Determination# 51622 Plan of Correction Brookdale Torbett Completion Date Review of Resident 7's TSP, dated 11/17/2024, showed that the resident had an altercation with another resident that resulted in a bruise and pain to the back of their head. Review of Resident 7's record showed that it did not include an investigation and interventions regarding their resident-to-resident altercation. 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.,,ijro daleTorbett is or will be in IP ,..- . compliance with this law and/ or regulation on (Date) '<-/ In addition, I will Implement a system to monitor and ensure continued compliance with . ttrequirement. ~~oeh h3/!{'!tf2~ ,1zl~J,2,L/ Administrator (or Representative) Date WAC 388-78A-2120 Monitoring residents' well-being.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . . 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 #: 2325 Compliance Determination # 48034 Plan of Correction Brookdale Torbett 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 10/01/2024 and 10/14/2024 of: Brookdale Torbett 221 Torbett St Richland, WA 99354 This document references the following complaint number(s): 149264, 150507, 150522 The following sample was selected for review during the unannounced on-site visit: 3 of 34 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Laurel Knight, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 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. 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. . Statement of Deficiencies License #: 2325 Compliance Determination # 48034 Plan of Correction Brookdale Torbett Completion Date Administrator (or Representative) Date RCW 70.129.140 Quality of life -- Rights. (1) The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality. WAC 388-78A-2660 Resident rights. The assisted living facility must: (1) Comply with chapter 70.129 RCW, Long-term care resident rights; This requirement was not met as evidenced by: Based on interview observation and record review, the Assisted Living Facility (ALF) failed to ensure a resident was treated with dignity and respect for 1 of 3 residents (Resident 1) who require assistance with their activities of daily living. This failure resulted in the resident being left with unmet needs and lying on a bare mattress for an extended period. Findings included… Revised Code of Washington (RCW) 70.129.140 (1) (1) The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality. Record review of Resident 1’s ALF Negotiated Service agreement (NSA) dated 08/21/2024 showed that Resident 1 had a diagnosis of and had a recent hip fracture. The healing fracture left Resident 1 unable to bear weight on the fracture side and their limited mobility left them at risk for skin breakdown on the backside of their body. Record review of the facility Incident Report dated 10/16/2024 showed that Resident 1 had multiple incontinence episodes during the night and required a full bedding change at 5:00 AM. The report showed that staff did not follow their shift change process to do room to room report on the residents at 6:00 AM due to short staffing on night shift. Resident 1 was found at 8:30 AM lying on the bare mattress covered with only a bed pad under their bottom. In an interview on 11/05/2024 at 10:30 AM, Collateral Contact 1 (CC1), stated that they observed Resident 1 in bed on 10/09/2024 at 8:30 AM. They stated that Resident 1 was wearing only a brief and had a cloth chair protector pad underneath their bottom. CC1 . . Statement of Deficiencies License #: 2325 Compliance Determination # 48034 Plan of Correction Brookdale Torbett Completion Date stated that there were no sheets on the bed or pillowcases on the pillows to protect the resident’s skin from being in direct contact with the vinyl mattress. CC1 stated they were concerned that Resident 1’s urinary catheter (tube inserted in the bladder) was not secured to their leg causing tension on the resident’s penis. In an interview on 11/06/2024 at 9:30 AM, Staff A, Administrator stated that staff on duty had not followed their usual procedure to check on residents in each room with the oncoming shift caused the delay in providing assistance to Resident 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, Brookdale Torbett 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 .

Conclusion/ Action: . Iii Failed Provider Practice Identified/ Citation(s) Written 0 Failed Provider Practice Not Identified / No Citation Written 0 N/A . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Statement of Deficiencies License#: 2325 Compliance Determination # 42001 Plan of Correction Brookdale Torbett 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 05/31/2024 and 05/31/2024 of: Brookdale Torbett 221 Torbett St Richland, WA 99354 This document references the following complaint number(s): 131882 The following sample was selected for review during the unannounced on-site visit: 2 of 34 current residents and 1 former residents. The department staff that investigated the Assisted Living Facility: Laurel Knight, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 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. 06/14/2024 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. . 06, 14.2024 09:01:04 State of Washin9ton 6/8 Statement of Deficiencies License #: 2325 Compliance Determination# 42001 Plan of Correction Brookdale Torbett Completion Date Page 2 of3 Licensee: EMERITUS CORPORATION 06/13/2024 ,, 1'': ___ :~-:J_ t / •-' IVe WAC 388-78A-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, rnust: (b) Develop and implement systems that support and promote safe medication service for each resident This requirement was not met as evidenced by: Based on observation, interview. and record review, the Assisted Living Facility (ALF) failed to ensure a safe medication system was implemented for 1 of 3 residents (Resident 1) reviewed for medication services_ These failures resulted in Resident 1 not receiving their medications as prescribed. Findings included". Review of the facility's policy titled, "Medication and Treatment Administration Assistance," revised on 03/31/2022, showed that medication assistance and administration would be in accordance with the prescriber's order. Staff would perform the checks to ensure that the right medication, and right dosage was given at the right time to the right resident by the right method prior to giving the medication. Review of the facility's policy titled "Medication and Treatment-Storage, Handling, Dispositioh and Payment," dated 11/15/2015 showed that new physician/healthcare provider orders would be obtained by the facility and accepted into the community using a consistent procedure_ The accepted medication would be immediately stored in accordance with their storage directions and by route of administration in the medication cart in preparation for medication delivery to the resident. Review of Resident 1·s Negotiated Service Agreement (NSA) dated 02/27/2024 showed that the facility managed and assisted Resident 1 with their medications. Resident 1' s diagnoses included _ Review of a Physician's Order dated 02/16/2024 at 3:45 PM showed that Resident 1 was to be given polyethylene glycol (medication for constipation) 17 grams in 4-8 ounces of water every day by mouth. The directions were to hold the medication if there were loose stools. . Statement of Deficiencies License#: 2325 Compliance Determination # 42001 Plan of Correction Brookdale Torbett Completion Date Page 2 of3 Licensee: EMERITUS CORPORATION 06/13/2024 __________________________________ _____________________ Administrator (or Representative) Date WAC 388-78A-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (b) Develop and implement systems that support and promote safe medication service for each resident. This requirement was not met as evidenced by: Based on observation, interview, and record review, the Assisted Living Facility (ALF) failed to ensure a safe medication system was implemented for 1 of 3 residents (Resident 1) reviewed for medication services. These failures resulted in Resident 1 not receiving their medications as prescribed. Findings included ... Review of the facility's policy titled, "Medication and Treatment Administration Assistance," revised on 03/31/2022, showed that medication assistance and administration would be in accordance with the prescriber's order. Staff would perform the checks to ensure that the right medication, and right dosage was given at the right time to the right resident by the right method prior to giving the medication. Review of the facility's policy titled "Medication and Treatment-Storage, Handling, Disposition and Payment," dated 11/15/2015 showed that new physician/healthcare provider orders would be obtained by the facility and accepted into the community using a consistent procedure. The accepted medication would be immediately stored in accordance with their storage directions and by route of administration in the medication cart in preparation for medication delivery to the resident. Review of Resident 1 's Negotiated Service Agreement (NSA) dated 02/27/2024 showed that the facility managed and assisted Resident 1 with their medications. Resident 1's diagnoses included . Review of a Physician's Order dated 02/16/2024 at 3:45 PM showed that Resident 1 was to be given polyethylene glycol (medication for constipation) 17 grams in 4-8 ounces of water every day by mouth. The directions were to hold the medication if there were loose stools. . 06.14.2024 09:01:04 State of Washington 7/8 Statement of Deficiencies License #: 2325 Compliance Determination# 42001 Plan of Correction Brookdale Torbett Completion Date Review of Resident 1 's March. April, and May 2024 Medication Administration Record (MAR) showed an order entered on 02/16/2023 that showed the resident was to receive polyethylene glycol 17 grams in 4-8 ounces of water every day by mouth as needed for constipation. The directions were to hold the medication if there were loose stools. Review of Resident 1' s medication list from their Primary Care Provider visit dated 02/16/2024 showed that Staff 8, Medication Technician (MT) marked in the tracking area tool to show they had sent the orders and made a note in the progress notes. The rest of the order tracking tool was left blank including Whether the MAR was reviewed. The fax cover sheet showed that the list was sent to the incorrectly listed PCP to confirm the medication order changes. During an interview on 05/31i2024 at 3:52 PM, Staff A, Regional Nurse stated that the medication list order clarification sent to the doctor on 02/16/2024 should have had the tracking information section completed. They stated that staff would have then noticed the transcription error when doing the MAR review. 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, Brookdale. Torbett is or will be in :2/21.J; l' Z3j . 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. t.Ll(tf'. Ql{lt4 Jz ~ /\Qi _fl) .(lg (a I' 24 c../ Administrator (or Representative) Date .

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: Brookdale Torbett Provider Type: Assisted Living Facility License/Cert.#: 2325 Compliance Determination #: 40439 Intake ID: 128568 Investigator: Laurel Knight Region/Unit #: RCS Region 1 / Unit G Investigation Date(s): 04/26/2024 through 05/23/2024 Complainant Contact Date(s): 04/26/2024, 05/23/2024 Allegation(s): 1. Identified resident was abused by another resident twice while at the facility. Investigation Methods: Sample: Total residents: 34 Resident sample size: 4 Closed records sample size: 0 Observations: Identified resident Residents Staff to resident interactions Interviews: Identified resident Nursing staff Residents Family members Record Reviews: Medical records including negotiated service agreement, notes, medication administration records, incident report and investigations. Investigation Summary: 1. The Identified resident was unable to communicate due to a cognitive disability. Their representative stated that the resident was sexually abused by another resident at the facility twice since moving in. The facility staff stated that they were unaware the incident had to be reported. The facility incident investigation showed the resident was assessed, monitored and assigned a one on one staff for safety. Failed practice identified. Please see the Statement of Deficiency dated 05/23/2024 WAC 388-78a-2630. 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 . Investigation Summary Report Provider/Facility: Brookdale Torbett Provider Type: Assisted Living Facility License/Cert.#: 2325 Compliance Determination #: 33187 Intake ID: 107377 Investigator: Laurel Knight Region/Unit #: RCS Region 1 / Unit G Investigation Date(s): 11/30/2023 through 12/15/2023 Complainant Contact Date(s): Allegation(s): 1. Identified resident missed their medications. Investigation Methods: Sample: Total residents: 30 Resident sample size: 3 Closed records sample size: 0 Observations: Identified resident Residents Staff to resident interactions Interviews: Identified resident Nursing staff Residents Family members Record Reviews: Medical records including negotiated service agreement, notes, medication administration records, incident report and investigations. State reporting log Incident investigation Facility policies Investigation Summary: 1. The identified resident's representative stated the resident had a seizure from running out of their medication. Facility staff interview confirmed the resident missed three doses of their anti- seizure medication due to medication unavailability. Facility records showed the resident was sent to the emergency department for evaluation and treatment where they determined it was a seizure due to missed medication. Deficient practice was identified. See the Statement of Deficiency dated 12/15/2023 for WAC 388-78a-2240. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written . Failed Provider Practice Not Identified / No Citation Written N/A . . . .