Aegis Living Greenwood.

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

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration PO Box 45600, Olympia, WA 98504-5600 September 25, 2025 ELECTRONIC-FACSIMILE Administrator Aegis Living Greenwood 10000 Holman Rd NW Seattle, WA 98177 Assisted Living Facility License # 2617 Licensee: Aegis Senior Communities LLC IMPOSITION OF CIVIL FINE Dear Administrator: On September 15, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a follow-up visit at your facility. This letter constitutes formal notice of a civil fine on the license for your assisted living facility, also known as Aegis Living Greenwood, located at 10000 Holman Rd NW, Seattle, by the State of Washington, Department of Social and Health Services. These actions are taken under the authority granted pursuant to Laws of 1998, Chapter 272 and RCW 18.20.190. The civil fine on the license is based on the following violation of the RCW and/or WAC as described in the attached Statement of Deficiencies (SOD) report dated September 15, 2025. Civil Fine WAC 388-78A-3100 (1)(2)(3)(4) Safe storage of supplies $300.00 and equipment. The licensee failed to ensure products that would be harmful if ingested were kept secure from cognitively impaired residents in two Memory Care Units (MCU) bathrooms. This failure placed 24 cognitively impaired residents at risk of harm. This is an uncorrected deficiency previously cited on July 11, 2025. NOTE: This is the violation, which resulted in the fine; see the attached Statement of Deficiencies for any additional violations. Administrator Aegis Living Greenwood License # 2617 September 25, 2025 Page 2 Attestation (Plan of Correction): Return the enclosed SOD within 10 calendar days with the following: • The date you have or will have each deficiency corrected; • A signature and date attesting that you are taking actions to correct and maintain correction for each cited deficiency. Return the signed and dated SOD to: Jamie Singer, Field Manager Region 2, Unit J 20311 52nd Avenue West Suite 100 Lynnwood, WA 98036 Phone: (253) 312-1446 / Fax: (206) 971-6791 rcsregion2email@dshs.wa.gov Appeal Rights: You have two appeal rights: Informal Dispute Resolution (IDR) and an Administrative Hearing. Each has a different request timeline. Informal Dispute Resolution [RCW 18.20.195] You have an opportunity to challenge the deficiencies and/or enforcement actions through the state's IDR process. All IDR requests must be in writing and include: • The deficiencies you are disputing; and • The method of review you prefer (face-to-face, telephone conference or documentation review). The written request must be received by the 10th working day from receipt of this letter. During the IDR process, you will have the opportunity to present written and/or oral evidence to dispute the deficiencies. Please email your request(s) and supporting documentation to: RCSIDR@dshs.wa.gov OR FAX to: 360-725-3225 Administrator Aegis Living Greenwood License # 2617 September 25, 2025 Page 3 Formal Administrative Hearing You may contest the civil fine by requesting a formal administrative hearing to challenge the deficiency, which resulted in the civil fine. All hearing requests must be in writing and include: • A copy of this letter; and • A copy of the Statement of Deficiencies. The written request must be received within twenty-eight (28) calendar days of receipt of this letter. Send your written request to: Office of Administrative Hearings PO Box 42489 Olympia, Washington 98504-2489 Payment: If you do not request a formal administrative hearing, the civil fine is due to the Office of Financial Recovery twenty-eight (28) calendar days after receipt of this letter. Mail a check for $300.00 payable to the ‘Department of Social and Health Services’, and if you have or have had a Medicaid resident(s), please include your ProviderOne ID Number # on the check, to: DSHS Office of Financial Recovery PO Box 9501 Olympia, WA 98507-9501 (360) 664-5919 / FAX: (360) 664-8401 OFRMMISVendor@dshs.wa.gov If the Office of Financial Recovery has not received your payment within twenty-eight (28) days after receipt of this letter, interest will begin to accrue immediately on the balance, at the rate of one percent per month. If you do not submit a hearing request or make payment within twenty-eight (28) days, the balance due will be recovered. Administrator Aegis Living Greenwood License # 2617 September 25, 2025 Page 4 NOTICE: State and federal law provide protections to defendants who are in military service, and to their dependents. Dependents of a service member are the service member’s spouse, the service member’s minor child, or and individual for whom the service member provided more than one-half of the individual’s support for one hundred eight days immediately preceding an application for relief. One protection provided is the protection against the entry of a default judgment in certain circumstances. This notice pertains only to a defendant who is a dependent of a member of the National Guard or a military reserve component under a call to active service, or a National Guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days. Other defendants in military service also have protections against default judgments not covered by this notice. If you are the dependent of a member of the national guard or a military reserve component under a call to active service, or a national guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days, you should notify the Department in writing of your status as such within twenty days of the receipt of this notice. If you fail to do so, then a court or an administrative tribunal may presume that you are not a dependent of an active duty member of the national guard or reserves, or a national guard member under a call to service authorized by the governor of the state of Washington, and proceed with the entry of an order of default and/or a default judgment without further proof of your status. Your response to the Department about your status does not constitute an appearance for jurisdictional purposes in any pending litigation nor a waiver of your rights. If you have any questions, please contact Jamie Singer, Field Manager, at (253) 312-1446. Sincerely, Matt Hauser Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 2, Unit J RCS Regional Administrator, Region 2 HCS Regional Administrator, Region 2 DDA Regional Administrator, Region 2 WA LTC Ombuds Office of Financial Recovery, Vendor Program Unit HQ Central Files DRW HP

Residential Care Services Investigation Summary Report Provider/Facility: Aegis Living Greenwood Provider Type: Assisted Living Facility License/Cert.#: 2617 Intake ID: 135203 Compliance Determination #: 43341 Region/Unit #: RCS Region 2 / Unit J Investigator: Cathy Prentice Investigation Date(s): 06/27/2024 through 08/05/2024 Complainant Contact Date(s): Allegation(s): There was a medication error for the named resident when the resident received half of the ordered medication since 03/02/24. Investigation Methods: Sample: Total residents: 70 Resident sample size: 6 Closed records sample size: 0 Observations: Named resident; delivery of care and services; staff interactions with residents; residents' appearance; environment. Interviews: Named resident, other residents, staff, administration, collateral contacts. Record Reviews: Resident care records, Assessment, Negotiated Service Agreement (NSA), investigations, grievances, facility policies, other pertinent records. Investigation Summary: Observation, interview and record review showed, the facility completed an Assessment and Negotiated Service Agreement that included the facility would manage and assist with medications for the named resident as well as receive medications from the facility pharmacy upon admission. The facility completed a thorough investigation to rule out abuse/neglect that substantiated medications errors of the wrong dose of an anticonvulsant medication from 03/02/24 through 06/15/24 due to a transcription error by a nurse. According to the state agency investigation, the named resident also missed medications 04/20/24 through 05/01/24 due to unavailability of the medication. The total doses of Depakote missed for Resident 1 was 92 doses due to transcription error and 22 doses due to medication unavailability for a total of 114 missed doses of Depakote due to transcription error and unavailability of medication on the part of the facility (does not include refused doses.) The facility failed to provide the named resident medications according to the physician prescribed medication order. See Statement of Deficiencies dated 08/05/2024. This document was prepared by Residential Care Services for the Locator website. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A 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. 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. This document was prepared by Residential Care Services for the Locator website.