Aegis of Madison.

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 70072 Intake ID: 202120 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 12/15/2025 through 01/14/2026 Complainant Contact Date(s): Allegation(s): A caregiver physically restrained the Named Resident (NR) when the NR was agitated during care that resulted in the NR's bruising on both hands, two open areas on the left hand, a skin tear top of the hand and side of the wrist when the caregiver pinned the NR down on the bed face down and held the NR's wrists to give care. The injuries required first aide from the nurse. Investigation Methods: Sample: Total residents: 80 Resident sample size: 3 Closed records sample size: 0 Observations: Named Resident (NR); 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 for the NR who resided in the memory care unit as required. The facility had a 1:1 caregiver assigned to the care of the NR for fall safety due to dementia, when the NR had bruising and open wounds with swelling on both hands and arms after receiving care from the named staff. The facility completed a thorough investigation to rule out abuse/neglect that was substantiated for abuse. The facility reported, provided protection and thoroughly investigated the physical abuse. Review of staff records showed the facility failed to ensure 4 of 4 staff had work references checked before hire, failed to ensure 3 of 4 staff completed the required trainings before working with residents. See Statement of Deficiencies dated 01/14/2026. 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. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 2 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 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. Residential Care Services 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-2450 Staff. (2) The assisted living facility must: (b) Verify staff persons' work references prior to hiring; (e) Ensure all resident care and services are provided only by staff persons who have the training, credentials, experience and other qualifications necessary to provide the care and services; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 4 of 4 staff (Staff B, C, D and E) had the required work reference checks before hire. These failures placed residents at risk of receiving care from staff when the ALF was unaware of their previous work performance and experience. Findings included… Review of staff records showed the ALF hired Staff B (Nurse Aide Certified pending) on 11/05/2025. Records showed the ALF had no application or resume on file to review work experiences and references, or to review to ensure the ALF checked the appropriate references. Review of Staff B’s reference check worksheet showed the ALF checked one work reference but did not date when the reference was checked, and did not include the employers name. In an interview, on 12/18/2025 at 2:00 PM, Staff A (Director of Resident Wellness), stated when she hired Staff B and he gave her a named ALF that he was currently working at. Staff A stated she did not check that work reference, at the named ALF, for Staff B. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 3 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 Record review showed the named ALF was not listed as reference checked on Staff B’s reference check worksheet. An email, dated 01/06/2026, from Staff G (Director of operations) confirmed the facility had no application or resume available on file for Staff B. Review of staff records showed the ALF hired Staff C (Nurse Aide Certified) on 11/02/2025. Record review of an employment record on staff application, and review of the work reference worksheet for Staff C, showed the ALF only checked one of those employers for a reference and did not date when the reference was checked. The reference check worksheet showed the second employer listed was not contacted for a reference. In an interview, on 12/18/2025 at 2:00 PM, Staff A stated sometimes they have the front desk call work references and she did not know why all work references were contacted for Staff C. Review of staff records showed the ALF hired Staff D (Home Care Aide) on 11/06/2025. Review of the employment record on the application and the reference check worksheet showed the ALF checked one work reference but did not date when the reference was checked. Review of staff records showed the ALF hired Staff E (Home Care Aide pending) 11/05/2025. Review of the employment record on the application and the reference check worksheet showed the ALF checked one work reference but did not date when the reference was checked. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 4 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 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, AEGIS OF MADISON 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 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: (a) Orientation and safety; (3) The assisted living facility must ensure that all staff receive appropriate training and orientation to perform their specific job duties and responsibilities. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure 3 of 4 staff (Staff B, D and E) completed facility orientation and training. These failures placed residents at risk of receiving care from untrained staff. Findings included… NOTE: Washington Administrative Code (WAC) 388-112A-0200- What is orientation training, who should complete it, and when should it be completed? There are two types of orientation training: Facility orientation training and long-term care worker orientation training. (1) Facility orientation. Individuals who are exempt from certification as described in RCW 18.88B.041 and volunteers are required to complete facility orientation training before having routine interaction with residents. This training provides basic introductory information appropriate to the residential care setting and population served. The department does not approve this specific orientation program, materials, or trainers. No test is required for this orientation. NOTE: WAC 388-78A-2450 – Staff (2) The assisted living facility must: (h) Provide staff orientation and appropriate training for expected duties when staff begin work in the facility, including, but not limited to: (i) Organization of the assisted living facility; (ii) This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 5 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 Physical assisted living facility layout; (iii) Specific duties and responsibilities; (iv) How to report resident abuse and neglect consistent with chapter 74.34 RCW and assisted living facility policies and procedures; (v) Policies, procedures, and equipment necessary to perform duties; (vi) Needs and service preferences identified in the negotiated service agreements of residents with whom the staff persons will be working; (vii) Resident rights, including without limitation, those specified in chapter 70.129 RCW; and (viii) The facility's comprehensive disaster plan and related on-duty staff procedures. Review of staff records showed the ALF hired Staff B (Nurse Aide Certified pending) on 11/05/2025. Records showed they worked their first shift with residents on 11/16/2026 as a one to one (1:1) caregiver on the memory care unit. The facility had no documentation of Staff B receiving facility orientation. In an interview, on 12/18/2025 at 2:00 PM, Staff A (Director of Resident Wellness) stated Staff B did not have facility orientation. Staff A stated she thought they had 30 days for that training. Review of an email, dated 12/16/2025, showed and confirmed Staff B did not have facility orientation. Review of staff records showed the ALF hired Staff D (Home Care Aide) on 11/06/2025. Records showed they worked their first shift with residents on 11/10/2025. Review of the facility safety orientation record dated 11/11/2025, showed Staff D did not receive the facility orientation until after she worked with residents. Review of staff records showed the ALF hired Staff E (Home Care Aide pending) on 11/05/2025, Records showed they worked their first shift with residents on 11/11/2025. Review of the orientation and safety certificate for Staff E showed, Staff E completed the training on 11/28/2025, 14 days after already working with residents. In an interview, on 12/18/2025 at 2:00 PM, Staff A stated she thought the ALF had 30 days for orientation training to be completed and was not aware it was required before working with residents. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 6 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 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, AEGIS OF MADISON 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 WAC 388-78A-2480 Tuberculosis Testing Required. (1) The assisted living facility must develop and implement a system to ensure each staff person is screened for tuberculosis within three days of employment. (2) For purposes of WAC 388-78A-2481 through 388-78A-2489 , "staff person" means any assisted living facility employee or temporary employee of the assisted living facility, excluding volunteers and contractors. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to have screening for tuberculosis (TB) through approved methods for 4 of 4 staff (Staff B, C, D and E) within three days of employment. This failure placed residents at risk for illness. Findings included… NOTE: Washington Administrative Code (WAC) 388-78A-2481 -Tuberculosis—Testing method—Required. The assisted living facility must ensure that all tuberculosis testing is done through either:(1) Intradermal (Mantoux) administration with test results read:(a) Within forty-eight to seventy-two hours of the test; and (b) By a trained professional; or (2) A blood test for tuberculosis called interferon-gamma release assay (IGRA). NOTE: WAC 388-78A-2485 -Tuberculosis—Positive test result. When there is a positive result to tuberculosis skin or blood testing the assisted living facility must:(1) Ensure that the staff person has a chest X-ray within seven days; (2)Ensure each resident or staff person with a positive test result is evaluated for signs and symptoms of tuberculosis; and (3) Follow the recommendation of the resident or staff person's health care provider. Review of staff records showed the ALF hired Staff B (Nurse Aide Certified pending) on This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 7 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 11/05/2025. Records showed Staff A had a chest x-ray completed on 11/10/2025, 5 days after employment. There were no records of a positive skin or blood test prior to the chest x-ray and no documented evaluation of signs and symptoms of disease that is required with a chest x-ray. In an email interview, dated 12/16/2025, Staff A (Director of Resident Wellness) stated Staff B had an allergy to TB testing solution and had an x-ray instead. Staff A confirmed Staff B did not have a blood test (alternative to using the intradermal solution) prior to the x-ray. Review of staff records showed the ALF hired Staff C (Nurse Aide Certified) on 11/02/2025. Records showed Staff C had a chest x-ray on 10/08/2025, almost a month before hire. There were no records of a positive skin or blood test prior to the chest x-ray and no documented evaluation of signs and symptoms of disease that is required with a chest x-ray. In an interview on 01/14/2026 at 3:00 PM, Staff A confirmed Staff C had no other TB testing at the facility. Review of staff records showed the ALF hired Staff D (Home Care Aide) on 11/06/2025. Records showed Staff D had a TB blood test on 12/17/2025, over a month after hire. In an email, dated 12/16/2025, Staff A stated Staff D missed the TB skin test reading and was sent for a blood test 12/17/2025. Review of staff records showed the ALF hired Staff E (Home Care Aide pending) on 11/05/2025. Records showed Staff C had a positive TB blood test on 12/10/2025, over a month after hire, was sent for an x-ray six days later on 12/16/2025. In an email dated 12/17/2025, Staff F (Administrator) stated there were no further TB records for Staff B, C, D, E at the ALF. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2241 Compliance Determination # 70072 Plan of Correction AEGIS OF MADISON Completion Date Page 8 of 8 Licensee: Aegis Senior Communities LLC 01/14/2026 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, AEGIS OF MADISON 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 This document was prepared by Residential Care Services for the Locator website.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 Aegis Senior Communities LLC AEGIS OF MADISON 2200 E Madison St Seattle, WA 98112 RE: AEGIS OF MADISON License# 2241 Dear Administrator: This letter addresses Compliance Determination(s) 66424 (Completion Date 10/01/2025) and 62980 (Completion Date 08/05/2025). The Department completed a follow-up inspection of your Assisted Living Facility on 10/01/2025 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-2210-2-b, WAC 388-78A-2210-1, WAC 388-78A-2210-1-a, WAC 388-78A-2210- 1-b The Department staff who did the on-site verification: Cathy Prentice, Complaint Investigator If you have any questions, please contact me at (253)312-1446. Sincerely, . s· ManT Jamie Singer, Field Region 2, Unit J Residential Care Services This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 62980 Intake ID: 187952 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 07/23/2025 through 08/05/2025 Complainant Contact Date(s): Allegation(s): 1. Named Resident (NR) 1 did not have pain patch applied on 07/20/2025 and NR 2 missed bedtime insulin on 07/20/2025 because there was no nurse on duty. Investigation Methods: Sample: Total residents: 84 Resident sample size: 5 Closed records sample size: 0 Observations: Named Residents (NR); delivery of care and services; staff interactions with residents; residents' appearance; environment. I Interviews: Named Resident, other residents, staff, administration Record Reviews: Resident care records, Assessment, Negotiated Service Agreement (NSA), investigations, grievances, facility policies Investigation Summary: Observation, interview and record review showed, the facility completed Assessments and Negotiated Service Agreements for the NR's as required. The facility failed to have a nurse on duty in the evening of 07/20/2025 and 07/21/2025 due to a nurse vacation, and two residents missed medications during that time. NR1 missed insulin and blood sugar check and NR2 missed application of a pain patch. See Statement of Deficiencies dated 08/05/2025. 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. Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 62980 Intake ID: 186212 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 07/23/2025 through 08/05/2025 Complainant Contact Date(s): 07/14/2025, 08/05/2025 Allegation(s): 1. The facility is understaffed and leaves nurses at risk to take care of 80 plus residents. Investigation Methods: Sample: Total residents: 84 Resident sample size: 5 Closed records sample size: 0 Observations: Observed ALF residents, delivery of care and services; staff interactions with residents; residents' appearance; environment. Interviews: Interviewed ALF residents, staff, administration. Record Reviews: Resident care records, Assessment, Negotiated Service Agreement (NSA), investigations, grievances, facility policies, other pertinent records. Investigation Summary: According to observation, interview and record review, the facility had Registered Nurses and Licensed Practical Nurses on duty seven days per week for twelve hour shifts. The facility failed to have a nurse on duty in the evening of 07/20/2025 and 07/21/2025 due to a nurse vacation, and two residents missed medications during that time. See Statement of Deficiencies dated 08/05/2025. 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. Page: . .1 09/9/2025 13: 08 PM~ _ .. T0_:.12.Q6.9.71.6.79.L .. F.ROM.:.8556396300 09.08 ..- 2025 ·.09:01 :29 :stai;;e of U&sh l.ngton 7113 ·• ·· ' . ..S TAT.E-·.OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVfC-Es· AGING AND, LONG, Tr;RM.SlJ~POR'r ADMINIS:t'.RA'.f'IO~l 20:iif~inc:J_Ava w, Sq1ta·1.oo, Lynnwoocli .WA '9803~ Stateme.r,t of D&fi~_lfllJcleis Licen~e #: 2241. Cornpliance Determ1n~tl911 # 6298.0 Plan of Correction- AEGIS OF MADISON Cornpletio:n Qate. Fiege_·1 of4 Licensee: Aegis.Senior Communities LLc· 08/05/202.5 You are .required. to be in aomplian(i:e at ali times with ali licensing iaws arid regula.ti~os·.to .maintain.yocrr Assisted U\ling Facilf~ license. data The departm·ent completed coliection for an .unannounced .on~-s./t~. cornplernt inve~tiga,tiqn .or: on 07'/23/2026 and 07/25/2025 A5GIS .OF MA.DISON' 2·200 EMaqison St Seattle, WA ee·:112 This. document references the followiri_g GO:n'lplail'.lt r:1',fmb\:Ji"(s); 18(;i:;212, 187952 The-following sample was selected for review du~lng the unannoun¢~d on~$itG Vi$/t 5 ·of 84 -cu.rrentres1<;.f e.nts -and 0: fon:ner .r~s1dants. Cathy Pr~mijce, Complaint l_nve.~~lgateir "from: bsHs, Aging a_nd i..ong-Term Sup,port Adr,n,inistratjQn Resitjenti~I Qar~ serviCS$,.R egion 2 , Unit J 20~11 52nd. Ave W, Suite 100 Lynnwood, 'WA ·8t'i036 This document was prepared by Residential Care Services for the Locator website. ;Jage: . .2 09/9/2025 13: 08 PM,.._ .. T0_:_12.Q6.9.7l.6_7.9.L __ F.ROM.:_8556396300 08,08.20~.0~:01:29 :state· of' Uashil)9tpn 6/13 Statern~nt of DefJGi,encles Llten_S(;} #: 2.241 Corrlpliance. Determination# 62980 Plan .of Corr.ection AEGIS OF MADIS.ON .. C-ompleVoh D~te -Page-2 of 4 .Ucei'Jsee~A egl~ Senior G<>'n'lrtitinlties .LLC 118/05/20~5 ~S. a re.s.Lilt'of-the.an-site visit{~), the d~_paf'tment.fou_nd .th~t you:~re-not in cqm:pllc:mce with the l1censin9. laws ancf regw_l~tions H $tated iii the cjte.q deficiencies in' the enclo$ed-report .. 013/18i2025 Date wt2I I uncf~r&tEjnd that t~ ·m.alht~iro (:In Assi.sted Livlhg Facility llcense-, th~ f~~illty mus.t.be in comPliance lfle.l tcSnslng laws and regulations. ot all .ff mo". · l1sLct0~ - ....~ . er A irtinistrator {or:Representative,J · te WAC ·.388-78A~2210 Medicati.oo servi.ces. '.(.1) Ar, S$$iste.d Hying faci_llfy providing rrie.dicC1tion.~erv1cE1, elth~r directly .or indite¢tly, m_u~t: cay IVieet the requirements of cnaptet 69A~ ROW Legend drug$' Ptescription drug_s. .a nd other applicaple statutes and adminrstrative rules; and .(b) Develop and i,npJemant. systems that support and promote safe _me.d_ication:-~er.v_jc~ for each :resident (2} the assisted livir.ig facility must i;msure the following_r esiden·ts receive their medications as pres~rf.t:ied .eice·pt as provided for ih WAC 38fl-781V2230. an~ 388-7$A. . 2250 : 1 JM· If file assfstecl living facllify provides· medlcatlor.i .administration services-, each resichmt who requires medication adtnihitstration and his or her·negotiated ·service agreement indicates the, assistad living fS.dlify will provide m~dfcation administration. T.hi"s r~ulre.m ent-was r:iot met as evidenced by: . 13assd, on i(lt~rvle.w and re9ord -rev1.~w. the A$S1St$d __L iv,ing F~Gifity (ALF) feJle~ to·ensur~ 2 of 5 sampled reside.lits (Resident 1 and 2),.w ho-required medicatio.n ~l"Oniinlstratlon, r~ceiveg their medication as prescribed. Thia.failur.iaresulta.din Resi"dehts 1 and 2 nofreceivi/'\gphysJcl~n'.s ·ordered medication and placed tf:ler.n at risk of harm·_ Findings inoludad.,. NQ'TE: W~shingt~m AdrT1lnistrSlti11e Code .(WAC)_·388;.78A-245b $taff. (1) Each ·assisted livin_g facility mvst.pro,vide sufficient, fr~ined staff persons tc:>:(a) Furnish thf3 Sf!rviqes and care need~d by .ea~h. rasidenLcbi1$istent wtth his or her riegotiaJed satvi~e $greernent. This document was prepared by Residential Care Services for the Locator website. Page: . .3 09/9/2025 13: 08 PM~ _ .. T0_:.12.Q6.9.71.6.79.L .. F.ROM.:.8556396300 .09.08,2025 ~:01 :29 St~te .Qf Washln$i.on 3/13 Staternent of Defici.ericies License·-,;; 2241 co,mpliarice Det~rminatl~n #·~29.80 Plan•of C.orrection ·AEGIS OF MADISON ·Cornpietion Dote P.ag&3 of4: 08L05/2025 RESIDENT 1 NOTE~M edlineplus.gov stated the medication I nsulih Uspro injection a.nd·g lafgine (B~~~gler) ins.ulin in were products used to treat dia.betes {ccmdrtipn which the boqy doefl not proquce in$ulir::i and therefore cannot control the amounl ot:s.ugar ir,i the blood). Use insuiin lispro and gl.ai:gtne injection products axaatly as.prescribe(:!. Record review ora FaceS.h~e.t; snowed .the· ALF admitted Resident 1 on /2025with a d_iagnos!s Qf . Rf3view.of ari')ndiviQt.:.1alized Servfde Plan (I.SP - equ,ivalent to a Negotiated B~rvi¢e Agreement, dated 06/18/20?5; showed Resident 1 required ALF··staff .aMistance w,th_. meqicatio·ns. . . ReMrd review of Resident 1's Jufy 2d25 M!i!dioation A<:lmii1i$tr.atior'i Recc;irq (MA,R) showei:f :;.n 'bl'dar;. ~ated 01(12i'2025, for Insulin Lisproi1ao1m1 K'iVJkpen (H1..1maiog Kwikperi) :z Vriits i17Ject~b1~·tour times daily before meal$ and at bedtime., hqld for. bjoqd sugar leS$ than ·120. The MAR sta,te~ the Uspr.o.was to be given at 9:00 PM by nµrs~ only, The. MAR showed the Li.$.pro was not given at 9:00 PM on 07/21/2025; and itwas doournent~dHw~ls riot given due to no nurse being.available in the ALF. The MAR also.showed the:blood SLIQar chepk was not c11arted as.done. ·R.e~r(;l rev/ew .ofRe~ic!i;nt r~ ~u,ly ~025 shtiw·ec( an· order. dated 06/20/2025. for Ba~ragler Kwikpeh :(.ln.~µlin) ·1O (r U.ni.ts/tllf inje¢t:8 l.;.lnit~ 't)ightly at. begtir:na. Th!€ . MAR s~ated··E?a~.~9.l~r' .jris.ulin:was t<;>:be given at 9,00 PMby iili~'6e .0.nly. The MAR '$.hbW~d the. eas)~gler was .not given ~t.:9:oo PM o.n. 011211202.6, a,:1c;1 ~w~s .de>cum.entecf I.twas not ~iy~n .du~ .t¢ n9 111.:1.rse b~ing: available ·irt t.he·.ALF, lr:J an. lri,terv!ew, on 07/25.1:2025 at ~r15 AM, Resider,t .. 1 confjrm~d he had rni ..s sed hi!r blood sLmar .cheok .an,d b~~time 1nsulipi.;, on 07/~1/2025, ~hd he•W3$1qld tf'\e n1,.1rse·wa$ .on .vacation. RESIDENT2 NOTE- Me91iriep1u~.goy s~ted th~.rt:iedlcatiort tentany[.topical pato_heswere ~.seq fo rel.ieve s~ere ar.id per$i$tent.pain in people who w~ra.tole~nt.(used tO. the. ·effeQts of the medic~tfqn) to,n~r9atic pain medic~tlons. and who were e~ected to need pain medicatlon aroi.Jhd.·the clock that catinQt b~ tr1?ate1:rwlth other m.edh:~ations. Fentar,yl pe.(ohe$ shocaltj .not be. stopped without talking ·to· a do,ctor . .R~card ·review·o f a Pac¢ She,et, shawsd ti:"leAL~·adrnitteq Resident. 2. Qn 2.02.2 wifh:a diagnosi$ of . R·evlew·of ~ri-1S~ ga~ed 07/03/20.2$>~howe.q Res1de'11t~ required. ALF staff a$sfstanc~ with rnedi~trons.· a.hd was re¢eiv.iiJQ s.ervtc~ ffom This document was prepared by Residential Care Services for the Locator website. Page: 4 09/9/2025 13: 08 PM~·-. T0_:_12.06.9.71.6_7.9.L __ FBOM.:_8556396300 t18,06,2025 1'18:01:W state or w~shington 10/13 Statement of Deflcie,1cfes. .Lic.ense #; 224 i compllancs betermin~tlon # 62980 Plan of Correction .AEG.lS OFMADISON Cqmpletion Qate ,Page 4, of 4 Lii;:~r'.lsee:Aegls Sen.ior Comm~oltie$ .LLC 08/05/20~5 hospice.( c;ar.e provfdei:f to tha 'terminally Ill), Recordreview ofResident 2's July 2025 MAR showed an order, dated 03/05/2024, for FeMtariy'I patch to tJ~ applied topically every 72 hours and fo, ''date and ihitisJ patch.'' The MAR showed the p~'tchwas not applied as ordered dn 07/20/2025. Record review ofR:tesid&nt 2'$ .July 2025 MARshoWEid Staff A (Licensad Nurse) 'docuhieritsd the on Fsntsmyl patch that she. rsr:n~ved 07/23/2025, was dated07/.17/.2025. . l.n .an ihterv1ewi on 07/25/2025 at2z('.)4 PM, Staff .s (Health $enilces. Director) stc:ited the mls.sed tnedic:1;;1tiolis and. blood $Ugar checks fo.r Rei,tdent 1 and the missed pain p~tch far Resi,d!';lhJ 2 in July Were d~,fe to no licensed nurse working in fhe evlf>nlng a~er 7:0Q PM on 07/~0/2025 and 07/21/2025. . This i's ~ recurring deficiency pre'itie>usly cited on 02/23/2024 and 09/.27/2024, P!antAtt&stat.itm StaterTient 1h ereby certi fY th~t I haV$ ~viewed thi$ report anci have taken orl wOilc I t{atk.e, ,aPclt~iveis. . me~sures to correc~ this.deficiency. Bytaki~g._this action~ AEGg orwm I . be 1n .cornpll.ance with this law ahdi or regulation on (Date) <fO. . In a~oitidn·;:l~w.i · flpler:nen·t a sy,stem to mohitor and ~nsure contlnued compliance wi1h t.t)is'requiremen · / l}oc,-'~ '. .._' _____,,...___ 9\.9 Admm1 rater (or Represehtative) Dat · 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 August 18, 2025 ELECTRONIC-FACSIMILE Administrator AEGIS OF MADISON 2200 E Madison St Seattle, WA 98112 Assisted Living Facility License #2241 Licensee: Aegis Senior Communities LLC IMPOSITION OF CIVIL FINE Dear Administrator: On August 5, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a complaint investigation at your facility. This letter constitutes formal notice of a civil fine on the license for your assisted living facility, also known as AEGIS OF MADISON, located at 2200 E Madison St, 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 August 5, 2025. Civil Fine WAC 388-78A-2210 (1)(a)(b)(2)(b) Medication services. $500.00 The licensee failed to ensure two residents who required medication administration received their medication as prescribed. This failure resulted in both residents not receiving physician's ordered medication and placed them at risk of harm. This is a recurring deficiency previously cited on February 23, 2024, and September 27, 2024. NOTE: This is the violation, which resulted in the fine; see the attached Statement of Deficiencies for any additional violations. Attestation (Plan of Correction): Administrator AEGIS OF MADISON License #2241 August 18, 2025 Page 2 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 OF MADISON License #2241 August 18, 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 $500.00 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 OF MADISON License #2241 August 18, 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 SN

Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 55471 Intake ID: 168737 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 02/27/2025 through 03/24/2025 Complainant Contact Date(s): 02/24/2025, 03/24/2025 Allegation(s): The Named Resident (NR) missed three doses of ordered blood pressure medication again due to facility not obtaining the medication when it ran out. Investigation Methods: Sample: Total residents: 86 Resident sample size: 3 Closed records sample size: 0 Observations: Named Resident (NR); 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 as required. The facility failed to have medication available for the NR which resulted in three days of missed doses of ordered blood pressure medication. See Statement of Deficiencies dated 03/24/2025. 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.

Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 34380 Intake ID: 108553 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 12/27/2023 through 02/23/2024 Complainant Contact Date(s): Allegation(s): The named resident went out to see family and returned with narcotics missing. Investigation Methods: Sample: Total residents: 98 Resident sample size: 4 Closed records sample size: 1 Observations: Named resident; delivery of care and services; staff interactions with residents; residents' appearance; environment, medication narcotic accounting system. Interviews: Named resident, other residents, staff, administration Record Reviews: Resident care records, Assessment, Negotiated Service Agreement (NSA), investigations, grievances, facility policies, other pertinent records. Investigation Summary: According to interview and record review, the facility failed to follow medication policy/procedures when the named resident returned form leave and narcotics were not accounted for, and when the facility dispensed routine medications in nine envelopes for the named resident's leave. 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. Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 34380 Intake ID: 110128 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 12/27/2023 through 02/23/2024 Complainant Contact Date(s): Allegation(s): 1. The named resident received the wrong dose of pain medication on two consecutive days. 2. The named resident had a fall on the night of the second day of wrong dose of pain medication. Investigation Methods: Sample: Total residents: 98 Resident sample size: 4 Closed records sample size: 1 Observations: Named resident; delivery of care and services; staff interactions with residents; residents' appearance; environment, medication delivery system Interviews: Named resident, other residents, staff, administration Record Reviews: Resident care records, Assessment, Negotiated Service Agreement (NSA), investigations, grievances, facility policies, other pertinent records. Investigation Summary: According to interview and record review, the facility 1. failed to provide medication as ordered by the physician when the facility gave the wrong dose of a pain medication on two consecutive days. 2. The named resident had an unwitnessed non-injury fall on the evening of the second wrong dose of the pain medication. Failed practice was found for medication errors. 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.

Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 32551 Intake ID: 103934 Investigator: Hayley Pinkham Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 11/15/2023 through 12/04/2023 Complainant Contact Date(s): Allegation(s): The Assisted Living Facility (ALF) posted and emailed a photo of the Named Resident (NR) without written consent. Investigation Methods: Sample: Total residents: 93 Resident sample size: 3 Closed records sample size: Observations: Identified resident Residents Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Identified resident Nursing staff Residents Family members Record Reviews: Medical records Facility policies Investigation Summary: Interview and observation of the NR showed the NR was unable to be fully interviewed, no observable concerns noted with the NR physical presentation. Interview with sampled residents and their collateral contacts showed no reported violations of privacy or reported care concerns. Record review showed the NR and his collateral contacts did not consent to the use of the NR's image to share internally of externally. Interview with the NR's collateral contact showed the ALF violated the residents rights to privacy. Deficient practice identified. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written This document was prepared by Residential Care Services for the Locator website. N/A This document was prepared by Residential Care Services for the Locator website.

Residential Care Services Investigation Summary Report Provider/Facility: AEGIS OF MADISON Provider Type: Assisted Living Facility License/Cert.#: 2241 Compliance Determination #: 22788 Intake ID: 77536 Investigator: Cathy Prentice Region/Unit #: RCS Region 2 / Unit J Investigation Date(s): 04/20/2023 through 04/20/2023 Complainant Contact Date(s): 04/11/2023, 04/12/2023, 04/13/2023, 04/20/2023 Allegation(s): It was stated the resident needs Latanoprost eye drops and facility did not give them eve of 04/06/2023. Investigation Methods: Sample: Total residents: 84 Resident sample size: 3 Closed records sample size: 0 Observations: Delivery of care and services; staff interactions with residents; residents' appearance; environment. Interviews: Named resident and legal representative, other residents, staff, administration Record Reviews: Resident care records, assessment, service agreement, medication records, facility policies and other pertinent records. Investigation Summary: According to observation, interview and record review, the facility provided care according to the assessment and negotiated service agreement,. The facility offered the named resident's eye medication on 04/06/2023 and other days as ordered by the physician but the named resident refused on multiple occasions in March and April 2023 because he wanted to keep the medications at bedside and give them himself. The facility assessed the named resident unsafe for self medication and the resident needed assist. The facility failed to notify the physician as required, when the named resident had a pattern of refusal of medication for his eyes. 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.