Quail Park Memory Care Residences of West Seattle.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration Residential Care Services • RCSIDR@dshs.wa.gov May 29, 2025 (email) Brian Anderson-Administrator Quail Park Memory Care Residences of West Seattle 4515 41st Avenue SW Seattle, WA 98116 IDR SCHEDULING LETTER TRADITIONAL-TELEPHONE License #2458 Dear Administrator: This letter will confirm your request for an Informal Dispute Resolution (IDR) regarding Statement of Deficiencies (SOD) dated May 15, 2025. Per our conversation, Scotti Bower, will meet with you via telephone on June 12, 2025 at 1:30. Please call 1-564-999-2000 using conference ID 226 395 317# to join the meeting. You indicated you are disputing the following citation(s): WAC 388-78A-2630 You indicated the following individuals will participate and represent your facility in the IDR process: Brian Anderson-Administrator and Katie Blanchard-Health and Wellness Director Please provide additional documentation specifically related to the citation(s) you are disputing at least one week prior to the scheduled IDR date by emailing them to RCSIDR@dshs.wa.gov (preferred), or by faxing them to (360) 725-3225. If you have any questions, please contact me at RCSIDR@dshs.wa.gov . Sincerely, Kim Friesz Kim Friesz-Administrative Assistant 3 IDR Program Residential Care Services Enclosure cc: Regional Administrator-Region 2 Field Manager, Region 2 Unit J State and Regional Long Term Care Ombuds Field File Central Files IDR File

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration Residential Care Services • RCSIDR@dshs.wa.gov June 12, 2025 (email) Licensee: Quail Park of West Seattle, LLC Quail Park Memory Care Residences of West Seattle 4515 41st Ave SW Seattle, WA 98116 IDR RESULTS ALF #2458 Dear Provider: Thank you for participating in the Informal Dispute Resolution (IDR) process. During the IDR we addressed your dispute identified in your IDR Request in response to the Statement of Deficiencies (SOD) report dated 05/15/2025. As discussed during the IDR, the following information was considered:  All materials presented by the Assisted Living Facility ;  All oral statements and explanations offered by the Assisted Living Facility;  Records gathered by the Residential Care Services (RCS) regional staff. After careful review and consideration, I have decided not to make any changes to SOD report dated 05/15/2025. Next Steps:  If you have not done so already, begin the process of correcting the disputed deficiency or deficiencies immediately.  Contact the local field manager if you need clarification related to the SOD report.  Within 10 calendar days after you receive this letter, complete, and return the “Plan/Attestation Statement” for all disputed deficiencies. o For each disputed deficiency, indicate the date you have or will have corrected each one. o Next to each disputed deficiency, sign and date certifying that you have or will correct each disputed deficiency. o Mail the “Plan/Attestation Statement” with original signatures to: Jamie Singer, Field Manager Residential Care Services Region 2, Unit J Preferred methods: eFax: (206) 971-6791 Email: rcsregion2email@dshs.wa.gov Optional method: 20311 52nd Ave W, Suite 100 Lynnwood, WA 98036  You must complete corrections within 45 days or less if directed by the department after review of your proposed correction dates. If you have any questions, please contact me at Scotti.Bower1@dshs.wa.gov. Sincerely, Scotti Bower IDR Program Manager Residential Care Services cc: Regional Administrator, Region 2 Field Service Administrator, Region 2 Field Manager, Region 2 Unit J Statewide Long Term Care Ombudsman Regional Long Term Care Ombudsman Central File IDR File

Residential Care Services Investigation Summary Report Provider/Facility: Quail Park Memory Care Provider Type: Assisted Living Facility Residences of West Seattle License/Cert.#: 2458 Intake ID: 132482 Compliance Determination #: 43095 Region/Unit #: RCS Region 2 / Unit J Investigator: Lisa Hauk Investigation Date(s): 06/24/2024 through 07/03/2024 Complainant Contact Date(s): Allegation(s): A Named Resident (NR) at the Assisted Living Facility (ALF) was left unattended for 5 to 6 hours because ALF staff were unaware the NR had returned from the hospital. Investigation Methods: Sample: Total residents: 44 Resident sample size: 2 Closed records sample size: 0 Observations: Identified resident Residents Activities Dining Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Administration Identified resident Identified staff Nursing staff Residents Family members Record Reviews: Medical records Incident investigation Facility policies Staff training records Investigation Summary: Staff at the ALF assisted the NR to her apartment upon return from the hospital on the evening shift and was helped to bed. The night shift at the ALF was aware of the NR's return and checked on her and assisted her throughout the night. The last time the NR was assisted was 5:30 or 6:00 AM. Day shift caregivers did not receive communication that the NR had returned to her apartment. The NR did not receive medications or breakfast on the day shift. Violation of regulations identified. See written citation WAC This document was prepared by Residential Care Services for the Locator website. 388-78-2160. 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. 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.