Riverview Manor.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: Riverview Manor Provider Type: Assisted Living Facility License/Cert.#: 2701 Compliance Determination #: 72848 Intake ID: 208937 Investigator: Felicia Cantu Region/Unit #: RCS Region 1 / Unit G Investigation Date(s): 02/12/2026 through 03/10/2026 Complainant Contact Date(s): Allegation(s): 1) The facility did not initiate doctor's orders for medication changes timely. 2) The facility did not follow their pre-admission process correctly. Investigation Methods: Sample: Total residents: 59 Resident sample size: 2 Closed records sample size: Observations: Residents Resident rooms Staff to resident interactions Resident to resident interactions Facility environment Interviews: Residents Facility staff Others not associated with the facility Record Reviews: Characteristic roster Facility policies Resident records (face sheets, care plans, assessments, chart notes) Investigation Summary: 1 Observations showed that staff to resident interactions appeared safe, helpful, and respectful. Interviews an record review showed that the facility had a process for receiving and ordering medications. No medication discrepancies found in sampled residents. No failed practice identified. 2) The facility had an unqualified assessor do a named resident's pre-admission assessment. Failed practice identified. WAC 388-78A-2080. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written . N/A . .

Findings Included… Review of the undated facility Policy, “Medication administration and documentation” showed that staff were to ensure that residents received their medications as ordered, that they were to not document a medication as given without administering it, and that if a medication was not available, that staff were to document it accurately. In an interview on 08/27/2025 at 1:30 PM, Staff A, Administrator, acknowledged that they were aware that Resident 1 had been out of their blood pressure medication and had missed several doses. Staff A also acknowledged Resident 3 and Resident 4 did not have all their medications available to them. Additionally, Staff A acknowledged that staff had been signing that medication had been given that were not at the facility. . Statement of Deficiencies License #: 2701 Compliance Determination # 64783 Plan of Correction Riverview Manor Completion Date <Resident 1> Review of Resident 1’s Negotiated Service Agreement (NSA), dated 03/31/2025, showed that the resident had diagnoses of and . Resident 1’s NSA showed that they required staff to provide medication assistance with administration and with ordering their medication through the facility’s preferred pharmacy. Review of Resident 1’s physician order, dated 07/17/2025, showed that the resident had been prescribed Donepezil (used to treat dementia) 5 milligrams (MG), every evening, starting 07/01/2025. Additionally, the physician order showed that Resident 1 required blood sugar checks twice a day. Review of Resident 1’s July 2025 MAR, showed that their Donepezil once daily medication, had been administered to them twice on 07/03/2025 through 07/06/2025. Additionally, Resident 1’s MAR did not document their blood sugar monitoring from 07/01/2025 through 07/31/2025. Review of Resident 1’s hospital discharge summary, dated 2025, showed that a physician at the hospital had made additional changes to their medications, that included Ferrous Sulfate (used to treat iron deficiency) 325 MG to be taken every other day and Furosemide (used to treat excess fluid and high blood pressure) 20 mg (2 tablets once daily). Additionally, the physician ordered Resident 1 Isosorbide Denitrate (used to lower blood pressure) 20 mg for the resident to start /2025. Review of Resident 1’s August 2025 MAR showed the following: - Ferrous Sulfate 325 mg was given daily, not every other day from 08/01/2025 08/19/2025. - Furosemide 20 mg medication was prescribed as 2 tablets once daily, the MAR showed that the medication was given 20 mg twice daily. - The MAR did not show Resident 1’s blood sugar had been monitored twice daily from 08/01/2025 through 08/13/2025. - Isosorbide Dinitrate 20 mg three time daily, the MAR showed that the medication was not available starting 08/13/2025. Resident 1’s MAR showed given by staff for 12 doses from 08/13/2025 through 08/18/2025. Review of the facility investigation, dated 08/28/2025, showed that staff had charted that the Isosorbide Denitrate medication for Resident 1 was administered. However, the investigation showed that the medication was out of stock at the facility from 08/13/2025 through 08/19/2025 and that the resident had missed 20 doses of their medication. The investigation showed that documentation for Resident 1 was, “Inconsistent and incorrect.” . Statement of Deficiencies License #: 2701 Compliance Determination # 64783 Plan of Correction Riverview Manor Completion Date <Resident 3> Review of Resident 3’s NSA, dated, 07/23/2025, showed that the resident had diagnoses of , and . Resident 3’s NSA showed that they required staff to provide medication assistance with administration and with ordering their medication through the facility’s preferred pharmacy. Review of Resident 3’s physician order, dated 07/16/2025, showed that they were prescribed: - -Carbidopa-Levodopa (used to treat symptoms of Parkinson’s disease) 50-200 mg four times daily was ordered to start on 07/10/2025. - Mirtazapine 15 mg (used to treat anxiety and depression) was ordered to start on 08/14/2025. - Quetiapine 50 mg (used to treat neurocognitive disorder with Lewy bodies) was ordered to start 07/23/2025 - Rasagiline 1 mg (used to treat symptoms of Parkinson’s disease), was ordered to start on 05/21/2025. - Trazodone 100 mg (used to treat symptoms of Lewy bodies and for sleep), was ordered to start on 07/01/2025. Review of Resident 3’s August 2025 MAR showed the following: - Carbidopa-Levodopa 50-200 mg was not available as of 08/14/2025. - Mirtazapine 15 mg, was not available as of 08/14/2025. - Quetiapine 50mg, showed a duplicate order, which showed that the medication was given twice on 08/20/2025 and 08/21/2025. - Rasagiline 1mg, showed as not available starting 08/13/2025 through 08/16/2025, given 08/23/2025 and 08/24/2025, and then not available from 08/19/2025 through 08/22/2025. - Trazodone 100 mg, showed as not available as of 08/10/2025. Review of Resident 3’s progress notes, dated 08/22/2025, showed that the resident had a duplicate order that needed to be removed of their Quetiapine 50 mg medication. Review of the facility incident investigation, dated 08/28/2025, showed that Resident 3 had, “Inconsistent and incorrect,” documentation in their record. The investigation showed that medication had been administered to Resident 3, when the medications were out of stock. <Resident 4> . Statement of Deficiencies License #: 2701 Compliance Determination # 64783 Plan of Correction Riverview Manor Completion Date Review of Resident 4’s NSA, revised on 07/22/2025, showed that the resident had diagnoses of , and . Resident 4’s NSA showed that they required staff to provide medication assistance with administration and ordering their medications through the facility’s preferred pharmacy. Review of Resident 4’s physician orders, reviewed by the facility nurse on 08/27/2025 showed that they were prescribed: - Buprenorphine Naloxone (used to treat pain) 2-0.5 mg once daily starting 06/12/2025. - Desvenlafaxine (used to treat major depressive disorder), 25 mg once daily to start on 02/03/2025. - Ezetimibe (used to treat high cholesterol) 10 mg once daily to start on 05/15/2025. - Trintellix (an antidepressant used to treat major depressive disorder) 10 mg Review of Resident 4’s July 2025 MAR showed the following: - Buprenorphine 2-05. MG, the MAR showed that Resident 4 had not been given their medication from 07/01/2025 through 07/06/2025. - Trintellix 10 mg, the MAR showed that the resident was, “Absent from the home without meds”, then showed that the medication was not available on 07/11/2025, administered on 07/13/2025, and that the medication was not available on 07/14/2025, and 07/15/2025. Review of Resident 4’s August 2025 MAR showed the following: - Desvenlafaxine Succinate 25 mg, the MAR showed that the medication was not available starting 08/07/2025, then was signed by staff as administered on 08/10/2025, 08/12/2025, 08/18-08/19/2025, and then not available 08/19/2025 through 08/27/2025. - Ezetimibe 10 mg, the MAR showed that the medication was not available and then was signed by staff as administered on 08/08/2025 through 08/27/2025. In an interview on 09/10/2025 at 10:15 AM, Resident 4 stated that they had missed doses of their medication Trintellix from 07/04/2025 through 07/15/2025 and that they felt, “Sick,” that they went through withdrawals, were tired, slept more, felt nauseous, and had a headache. . Additionally, Resident 4 stated that they were not out of the facility and that the dates that showed they were given the medication on the MAR, they were not. Resident 4 also stated they had missed doses of their Buprenorphine and had also not been given their Desvenlafaxine or Ezetimibe medication since 08/07/2025 . Statement of Deficiencies License #: 2701 Compliance Determination # 64783 Plan of Correction Riverview Manor Completion Date 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, Riverview Manor 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-2240 Nonavailability of medications. When the assisted living facility has assumed responsibility for obtaining a resident's prescribed medications, the assisted living facility must obtain them in a correct and timely manner. This requirement was not met as evidenced by: Based observation, interview and record review, the facility failed to ensure that resident medications were obtained when staff were responsible to order medications for 4 of 5 residents (Residents 1, 3, 4 and 5). This failure resulted in residents not receiving their medications, and put them at risk of a decline in their chronic health conditions.

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 #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date Page 1 of 6 Licensee: Olympic Holdings - Riverview, LLC 01/29/2025 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 the unannounced on-site full inspection and complaint investigation on 01/08/2025, 01/09/2025, 01/10/2025, 01/13/2025 and 01/14/2025 of: Riverview Manor 555 E Goodlander Rd Selah, WA 98942 This document references the following complaint numbers: 161845, 161589, 162699, 162400. The following sample was selected for review during the unannounced on-site visit: 7 of 60 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Tracy Ramirez, Assisted Living Facility Licensor Anna Cairns, ALF Long Term Care Surveyor Tracy Ramirez, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 1 , Unit G 1200 Alder Street Union Gap, WA 98903 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date Page 2 of 6 Licensee: Olympic Holdings - Riverview, LLC 01/29/2025 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 246-980-030 Can a nonexempt long-term care worker work before obtaining certification as a home care aide? (1) A nonexempt long-term care worker may provide care before receiving certification as a home care aide if all the following conditions are met: (b) The long-term care worker must submit an application for home care aide certification to the department within fourteen calendar days of hire. An application is considered to be submitted on the date it is post-marked or, for applications submitted in person or online, the date it is accepted by the department. WAC 388-78A-2450 Staff. (3) The assisted living facility must: (d) Maintain the following documentation on the assisted living facility premises, during employment, and at least two years following termination of employment: (i) Staff orientation and training or certification pertinent to duties, including, but not limited to: (B) Home care aide certification as required by this chapter and chapter 246-980 WAC; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure that a Home Care Aide (HCA) application was sent to the department within 14 days of hire for 2 of 2 staff (Staff A and B). This failure placed residents at risk of being cared for by unqualified staff and disabled the department Review of personnel file for Staff C, Care Aide, showed that they were hired on 04/26/2024. Staff C’s file showed that they had a credential that had expired on 06/30/2019. Additionally, Staff C’s file did not include an HCA application that was sent to the department, which was required 248 days prior. Further record review of Staff C’s This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date Page 3 of 6 Licensee: Olympic Holdings - Riverview, LLC 01/29/2025 file showed that no training requirements towards their HCA license had been completed. Review of personnel file for Staff D, Care Aide, showed that they were hired on 10/10/2024. Staff D’s file did not include an HCA application that was sent to the department, which was required 81 days prior. Further record review of Staff D’s file showed that no training requirements towards their HCA license had been completed. In an interview on 01/13/2025 at 4:10 PM, Staff A, Administrator, stated that they did not complete an HCA application for Staff C and Staff D. 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, Riverview Manor 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-2240 Nonavailability of medications. When the assisted living facility has assumed responsibility for obtaining a resident's prescribed medications, the assisted living facility must obtain them in a correct and timely manner. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure that residents’ medications were obtained for 1 of 7 residents (Resident 2). This failure placed the resident at risk of complications with their health conditions. Findings included… Review of the facility policy, titled, “Unavailable Medications,” undated, showed that all medications that are the responsibility of the facility would be provided to the resident in a timeframe and manner to promote the health and welfare of the resident. Review of the characteristic roster, dated 01/08/2025, showed that Resident 2 was admitted to the facility on /2024. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date Page 4 of 6 Licensee: Olympic Holdings - Riverview, LLC 01/29/2025 Review of Resident 2’s Negotiated Service Agreement, dated /2024, showed that the resident required medication services by facility staff. Review of Resident 2’s record showed that the resident did not have a Medication Administration Record (MAR). Review of Resident 2’s physician visit progress note, dated 09/06/2024, showed that the resident had depression with anxiety, vitamin D deficiency, hyperlipidemia (high cholesterol) that required monitoring, and prediabetes that showed elevated A1C (lab test that shows an overall blood sugar levels) levels. Additionally, the progress note showed that the resident had prescribed orders for metformin (taken to control blood sugar in the body), vitamin D (medication for severe vitamin D deficiency), and duloxetine (taken for depression and anxiety). In an interview on 01/08/2025 at 8:58 AM, Staff A, Administrator, stated that Resident 2 had not been given their prescribed medications since their physician orders dated 09/06/2024. 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, Riverview Manor 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-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (a) Meet the requirements of chapter 69.41 RCW Legend drugs Prescription drugs, and other applicable statutes and administrative rules; and (b) Develop and implement systems that support and promote safe medication service for each resident. (2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250 : This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date Page 5 of 6 Licensee: Olympic Holdings - Riverview, LLC 01/29/2025 (a) Each resident who requires medication assistance and his or her negotiated service agreement indicates the assisted living facility will provide medication assistance; and (b) If the assisted living facility provides medication administration services, each resident who requires medication administration and his or her negotiated service agreement indicates the assisted living facility will provide medication administration. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure medication was given as prescribed and failed to develop and ensure a safe medication system was in place for residents who required assistance and administration with their medication for 1 of 7 residents (Residents 3). These failures resulted in wrong medications being administered to the resident, that put the resident at risk for health complications. Findings included… <Resident 3> Review of Resident 3’s, Negotiated Service Agreement (NSA), dated 07/15/2024, showed that the resident received medication services at the facility. The NSA showed that the resident had a diagnosis of , and . The NSA showed that Resident 3 had insulin (an injected medication to regulate the body’s blood sugar) and blood sugar checks provided by the facility staff. Review of Resident 3’s Medication Administration Record (MAR) for December 2024, showed that the resident did not receive their Toujeo insulin (injectable medication to regulate the body’s blood sugar) from 12/17/2024 through 12/23/2024. In an interview on 01/14/2024 at 8:00 AM, Staff A, Administrator acknowledged that that MARs showed that Resident 3’s insulin medication was not given. This document was prepared by Residential Care Services for the Locator website. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Olympic Holdings - Riverview, LLC Riverview Manor 555 E Goodlander Rd Selah, WA 98942 RE: Riverview Manor # 2701 Dear Administrator: This document references the following complaint numbers 161845, 161589, 162699, 162400. The Department completed a full inspection and complaint investigation of your Assisted Living Facility on 01/29/2025 and found that your facility does not meet the Assisted Living Facility requirements. The Department: • Wrote the enclosed report; and • May take licensing enforcement action based on many deficiency listed on the enclosed report; and • May inspect your program to determine if you have corrected all deficiencies; and • Expects all deficiencies to be corrected within the timeframe accepted by the department. You Must: • Begin the process of correcting the deficiency or deficiencies immediately; • Contact the Field Manager for clarifications related to the Statement of Deficiencies (SOD); • Within 10 calendar days after you receive this letter, complete and return the enclosed 'Plan/Attestation Statement'; o Sign and date the enclosed report; o For each deficiency, indicate the date you have or will correct each deficiency; o Return the Plan/Attestation Statement and report with signatures to: Laura Williams-Davis, ALF Field Manager This document was prepared by Residential Care Services for the Locator website. Riverview Manor # 2701 01/29/2025 Page 2 of 3 Residential Care Services Region 1, Unit G Preferred methods: eFax: (509) 454-4160 Email: rcsregion1email@dshs.wa.gov Optional method: 1200 Alder Street Union Gap, WA 98903 • Complete correction(s) within 45 days, or sooner if directed by the Department, after review of your proposed correction dates. • Have your plan approved by the Department. Consultation(s): In addition, the Department provided consultation on the following deficiency or deficiencies not listed on the enclosed report. WAC 388-78A-2090 Full assessment topics. The assisted living facility must obtain sufficient information to be able to assess the capabilities, needs, and preferences for each resident, and must complete a full assessment addressing the following, within fourteen days of the resident's move-in date, unless extended by the department for good cause: (6) Significant known behaviors or symptoms of the individual causing concern or requiring special care, including: (d) Individual's ability to leave the assisted living facility unsupervised; and (8) Individual's level of personal care needs, including: (b) Medication management ability, including: (i) The individual's ability to obtain and appropriately use over-the-counter medications; and (ii) How the individual will obtain prescribed medications for use in the assisted living facility. The Assisted Living Facility did not ensure that the required elements were included in each resident’s records. The facility plans to include additional elements not previously included in the resident's records for any future resident assessments. WAC 388-78A-2380 Freedom of movement. An assisted living facility must ensure all of the following conditions are present before moving residents into units or buildings with exits that may restrict a resident's egress: (3) The assisted living facility must have a system in place to inform and permit visitors, staff persons and appropriate residents how they may exit without sounding the alarm. This document was prepared by Residential Care Services for the Locator website.

Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor 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 the unannounced on-site full inspection and complaint investigation on 01/08/2025, 01/09/2025, 01/10/2025, 01/13/2025 and 01/14/2025 of: Riverview Manor 555 E Goodlander Rd Selah, WA 98942 This document references the following complaint numbers: 161845, 161589, 162699, 162400. The following sample was selected for review during the unannounced on-site visit: 7 of 60 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Tracy Ramirez, Assisted Living Facility Licensor Anna Cairns, ALF Long Term Care Surveyor Tracy Ramirez, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration 1200 Alder Street Union Gap, WA 98903 . Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor 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 246-980-030 Can a nonexempt long-term care worker work before obtaining certification as a home care aide? (1) A nonexempt long-term care worker may provide care before receiving certification as a home care aide if all the following conditions are met: (b) The long-term care worker must submit an application for home care aide certification to the department within fourteen calendar days of hire. An application is considered to be submitted on the date it is post-marked or, for applications submitted in person or online, the date it is accepted by the department. WAC 388-78A-2450 Staff. (3) The assisted living facility must: (d) Maintain the following documentation on the assisted living facility premises, during employment, and at least two years following termination of employment: (i) Staff orientation and training or certification pertinent to duties, including, but not limited to: (B) Home care aide certification as required by this chapter and chapter 246-980 WAC; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure that a Home Care Aide (HCA) application was sent to the department within 14 days of hire for 2 of 2 staff (Staff A and B). This failure placed residents at risk of being cared for by unqualified staff and disabled the department Review of personnel file for Staff C, Care Aide, showed that they were hired on 04/26/2024. Staff C’s file showed that they had a credential that had expired on 06/30/2019. Additionally, Staff C’s file did not include an HCA application that was sent to the department, which was required 248 days prior. Further record review of Staff C’s . Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date file showed that no training requirements towards their HCA license had been completed. Review of personnel file for Staff D, Care Aide, showed that they were hired on 10/10/2024. Staff D’s file did not include an HCA application that was sent to the department, which was required 81 days prior. Further record review of Staff D’s file showed that no training requirements towards their HCA license had been completed. In an interview on 01/13/2025 at 4:10 PM, Staff A, Administrator, stated that they did not complete an HCA application for Staff C and Staff D. 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, Riverview Manor 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-2240 Nonavailability of medications. When the assisted living facility has assumed responsibility for obtaining a resident's prescribed medications, the assisted living facility must obtain them in a correct and timely manner. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure that residents’ medications were obtained for 1 of 7 residents (Resident 2). This failure placed the resident at risk of complications with their health conditions. Findings included… Review of the facility policy, titled, “Unavailable Medications,” undated, showed that all medications that are the responsibility of the facility would be provided to the resident in a timeframe and manner to promote the health and welfare of the resident. Review of the characteristic roster, dated 01/08/2025, showed that Resident 2 was admitted to the facility on /2024. . Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date Review of Resident 2’s Negotiated Service Agreement, dated /2024, showed that the resident required medication services by facility staff. Review of Resident 2’s record showed that the resident did not have a Medication Administration Record (MAR). Review of Resident 2’s physician visit progress note, dated 09/06/2024, showed that the resident had depression with anxiety, vitamin D deficiency, hyperlipidemia (high cholesterol) that required monitoring, and prediabetes that showed elevated A1C (lab test that shows an overall blood sugar levels) levels. Additionally, the progress note showed that the resident had prescribed orders for metformin (taken to control blood sugar in the body), vitamin D (medication for severe vitamin D deficiency), and duloxetine (taken for depression and anxiety). In an interview on 01/08/2025 at 8:58 AM, Staff A, Administrator, stated that Resident 2 had not been given their prescribed medications since their physician orders dated 09/06/2024. 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, Riverview Manor 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-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must: (a) Meet the requirements of chapter 69.41 RCW Legend drugs Prescription drugs, and other applicable statutes and administrative rules; and (b) Develop and implement systems that support and promote safe medication service for each resident. (2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250 : . Statement of Deficiencies License #: 2701 Compliance Determination # 52689 Plan of Correction Riverview Manor Completion Date (a) Each resident who requires medication assistance and his or her negotiated service agreement indicates the assisted living facility will provide medication assistance; and (b) If the assisted living facility provides medication administration services, each resident who requires medication administration and his or her negotiated service agreement indicates the assisted living facility will provide medication administration. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure medication was given as prescribed and failed to develop and ensure a safe medication system was in place for residents who required assistance and administration with their medication for 1 of 7 residents (Residents 3). These failures resulted in wrong medications being administered to the resident, that put the resident at risk for health complications. Findings included… <Resident 3> Review of Resident 3’s, Negotiated Service Agreement (NSA), dated 07/15/2024, showed that the resident received medication services at the facility. The NSA showed that the resident had a diagnosis of , and . The NSA showed that Resident 3 had insulin (an injected medication to regulate the body’s blood sugar) and blood sugar checks provided by the facility staff. Review of Resident 3’s Medication Administration Record (MAR) for December 2024, showed that the resident did not receive their Toujeo insulin (injectable medication to regulate the body’s blood sugar) from 12/17/2024 through 12/23/2024. In an interview on 01/14/2024 at 8:00 AM, Staff A, Administrator acknowledged that that MARs showed that Resident 3’s insulin medication was not given. .

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 .