Ida Culver House Broadview.

Residential Care Services Investigation Summary Report Provider/Facility: IDA CULVER HOUSE Provider Type: Assisted Living Facility BROADVIEW License/Cert.#: 945 Intake ID: 210730 Compliance Determination #: 72746 Region/Unit #: RCS Region 2 / Unit J Investigator: Michelle Mcglon Investigation Date(s): 02/10/2026 through 02/25/2026 Complainant Contact Date(s): Allegation(s): 1. The Named Staff (NS) was instructed to clock out at their scheduled time, after the Named Resident (NR) had a fall, leaving multiple residents unattended. 2. The NR refused assistance with incontinence care, resulting in being soiled for an unknown amount of time at the Assisted Living Facility (ALF). 3. The NR should be a two person assist with care due to aggressive behaviors. 4. The NS remained with the ALF residents, resulting in missed break and written disciplinary action. Investigation Methods: Sample: Total residents: 97 Resident sample size: 3 Closed records sample size: Observations: Residents Activities Dining Staff to resident interactions Resident to resident interactions Interviews: Nursing staff Residents Activity Staff Executive Director Record Reviews: State reporting log Resident Records Investigation Summary: 1. Interview and record review showed the ALF had adequate staff per floor for each shift allowing staff to safely clock out at their scheduled time. The ALF staff reported a care staff was in the common area to supervise the residents at all times. The fall was not a result of the NS clocking out. Record review of a working schedule showed the ALF had adequate staffing. No failed practice identified. 2. Interview and record review showed that the NR had refused staff assistance with care. The ALF staff reported the NR had aggressive behaviors and would refuse. This document was prepared by Residential Care Services for the Locator website. Record review showed the ALF had interventions in place, including reapproaching the NR. No failed practice identified. 3. Interview and record review showed the ALF failed to provide have two caregivers when providing care and transfers. This failure may have contributed to the NR falling at the ALF. Failed practice identified. See Statement of Deficiency 388-78A-2160. 4. Interview and record review showed the ALF had adequate staffing. The ALF staff reported having adequate staff to take breaks as scheduled. Record review showed adequate staffing to accommodate breaks. Sampled resident representatives reported care staff always being available. Unable to substantiate. No failed practice identified. 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. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES HOME AND COMMUNITY LIVING ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 Statement of Deficiencies License #: 945 Compliance Determination # 72746 Plan of Correction IDA CULVER HOUSE BROADVIEW Completion Date Page 1 of 3 Licensee: BROADVIEW DEVELOPMENT ASSOCIATES II 02/25/2026 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 02/10/2026 of: IDA CULVER HOUSE BROADVIEW 12505 GREENWOOD AVE N SEATTLE, WA 98133 This document references the following complaint number(s): 210730 The following sample was selected for review during the unannounced on-site visit: 3 of 97 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Michelle Mcglon, Nursing Consultant Institutional From: DSHS, Home and Community Living Administration Residential Care Services, Region 2 , Unit J 20311 52nd Ave W, Suite 100 Lynnwood, WA 98036 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.

—: WA DSHS report: Inspections (03/2024)