Cottages of Sequim.

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.

Conclusion / Action: . Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 800 NE 136th Ave Ste 200, Vancouver, WA 98684 Statement of Deficiencies License #: 2699 Compliance Determination # 48003 Plan of Correction Cottages of Sequim 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 an unannounced on-site complaint investigation on 10/01/2024 and 10/18/2024 of: Cottages of Sequim 408 W Washington St Sequim, WA 98382 This document references the following complaint number(s): 145390 The following sample was selected for review during the unannounced on-site visit: 3 of 45 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Pamela Horlick, NCI RN Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 800 NE 136th Ave Ste 200 Vancouver, WA 98684 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. . Statement of Deficiencies License #: 2699 Compliance Determination # 48003 Plan of Correction Cottages of Sequim Completion Date Administrator (or Representative) Date WAC 388-78A-2610 Infection control. (1) The assisted living facility must institute appropriate infection control practices in the assisted living facility to prevent and limit the spread of infections. (2) The assisted living facility must: (a) Develop and implement a system to identify and manage infections; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure appropriate infection control practices were implemented for 2 of 3 staff (Staff B and Staff C) reviewed. This failure placed 45 of 45 residents and 23 staff at risk of a spreading an infectious disease. Findings included… WAC 296-842-14005 “Provide medical evaluations. Medical Evaluation Process Step 1: Identify employees who need medical evaluations AND determine the frequency of evaluations from Table 7. Include employees who: (a) Are required to use respirators; or Step 6: Obtain a written recommendation from the LHCP [Licensed Health Care Professional] that contains only the following medical information: (a) Whether or not the employee is medically able to use the respirator; (b) Any limitations of respirator use for the employee; (c) What future medical evaluations, if any, are needed; (d) A statement that the employee has been provided a copy of the written recommendation” WAC 296-842-15005 “Conduct fit testing. (1) Provide, at no cost to the employee, fit tests for ALL tight fitting respirators on the following schedule: (a) Before employees are assigned duties that may require the use of respirators; (b) At least every twelve months after initial testing;” Review of facility a policy titled, “Fit-Testing Basics and Options”, dated 02/13/2024, . Statement of Deficiencies License #: 2699 Compliance Determination # 48003 Plan of Correction Cottages of Sequim Completion Date under section, “Fit Testing 101,” showed, “A respirator is a critical defense against respiratory hazards, including COVID-19 [Corona Virus Disease 2019- a respiratory illness]. A respirator works by filtering air inhaled by its wearer. This filtration is only effective if the seal is complete-if contaminants get around the filter, the wearer is at risk. Fit testing is an important and legally- required precaution for workers that require respirators. Fit testing ensures that the respirator properly seals against the wearers face, preventing contaminants from sneaking around the filter.” Under the section titled, “Employers must enact a respiratory protection program,” showed “Fit testing is just one element of worker respiratory protection. Chapter 296-842 of the Washington Administrative Code details an employers obligations when workers encounter hazards that require respirator use. Employer responsibilities include designation of an administrator, regulating voluntary respirator use, maintenance of a written program, record keeping, medical evaluation, fit testing, and training. Each is a legal requirement.” Under the section titled, “Medical evaluation is required before fit testing,” showed, “The person to be fit tested must complete a medical questionnaire prior to fit testing. A licensed health care professional, paid by the employer, must review and approve the questionnaire. Typically, occupational health clinics are able to review and approve medical questionnaires and immediately proceed with fit testing in a single appointment. Employers that self- administer fit testing should contract with an external LHCP for medical evaluations-the employer must not review the questionnaire or other privileged medical information from the person to be fit tested.” Review of a facility policy titled, “Respiratory Protection Program,” dated 05/01/2023, stated, “CarePartners Respiratory Protection Program is designed to maximize protection afforded by respirators when they must be used. It establishes procedures necessary to meet the regulatory requirements described in OSHA’s [Occupational Safety and Health Administration] Respiratory Protection standard 29 CFR 1910.134.” Under section titled, “Facility Administrator,” showed, “Facility Administrator or designee is responsible for ensuing that each employee is fit tested annually or if other circumstances such as significant weight loss/gain require staff member to be refitted.” Under the section titled, “Medical Evaluation,” stated Employees who are required to wear respirators must complete a medical evaluation check sheet and meet the criteria prior to being approved to wear a respirator. Any employee refusing the medical evaluation will not be allowed to work in an area requiring respirator use.” Under the section titled, “Fit testing,” showed, “Employees who are required to wear tight fitting air purifying respirators will be fit tested: prior to being allowed to wear any respirator with a tight-fitting face piece and annually, or when there are changes in the employees physical condition that could affect fit.” Under the section titled, “Documentation and Recordkeeping,” stated, “A written copy of this program and OSHA Respiratory Protection Standard shall be kept in the Program Administrators office and made available to all employees who wish to review it. Copies of training and fit test records shall be maintained by the Program Administrator or designee. These records will be updated as new employee’s are trained, as existing employees receive refresher training and as new fit tests are conducted. For employees covered under the Respiratory Protection Program, the Program Administrator shall maintain copies of the medical evaluation for employee’s ability to wear a respirator. The completed medical questionnaires and evaluations will remain confidential in the employee’s records.” Review of United States Environmental Protection Agency website, dated 08/27/2024, showed under section “Indoor Air and Coronavirus (Covid-19)”, showed, “Spread of . Statement of Deficiencies License #: 2699 Compliance Determination # 48003 Plan of Correction Cottages of Sequim Completion Date COVID-19 occurs via airborne particles and droplets. People who are infected with COVID can release particles and droplets of respiratory fluids that contain SARS CoV-2 virus into the air when they exhale (e.g., quiet breathing, speaking, singing, exercise, coughing, sneezing). The droplets or aerosol particles vary across a wide range of sizes-from visible to microscopic. Once infectious droplets and particles are exhaled, they move outward from the person (the source). These droplets carry the virus and transmit infection. Indoors, the very fine droplets and particles will continue to spread through the air in the room or space and can accumulate.” Review of Centers for Disease Control (CDC) website, titled, “Transmission-Based Precautions,” dated 04/03/2024, showed, “Use airborne Precautions for patients known or suspected to be infected with pathogens transmitted by the airborne route…Use personal protective equipment (PPE) appropriately, including a fit-tested NIOSH-approved N95 or higher level respirator for healthcare personnel.” In an interview on 09/30/2024 at 2:59 PM, Collateral Contact 1, Public Health Nurse, stated the facility had a COVID-19 outbreak from 09/04/2024-09/24/2024 and the facility was to ensure that staff were fit tested and had medical clearances for fit testing. Record review of the facility staff list, dated 10/02/2024, showed Staff B, Medication Technician/Caregiver, was hired on 02/01/2024. Record review of staff working schedule for September 2024, showed, Staff B worked on 09/01/24, 09/03/2024, 09/04/2024, 09/05/2024, 09/06/2024, 09/12/2024, 09/13/2024, and 09/14/2024 during the covid 19 outbreak. Record review of facility’s fit test records on 10/01/2024, showed Staff B’s N95 fit test record expired on 09/07/2024 and to had last been done on 09/07/2023.