Aegis Living Callahan House.

—: WA DSHS report: Inspections (09/2025)

—: WA DSHS report: Investigations (03/2025)

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. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 20311 52nd Ave W, Suite 100, Lynnwood, WA 98036 Statement of Deficiencies License #: 2589 Compliance Determination # 37666 Plan of Correction Aegis Living Callahan House Completion Date Page 4 of 7 Licensee: 15100 1st Ave Shoreline LLC 03/12/2024 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 03/05/2024 and 03/07/2024 of: Aegis Living Callahan House 15100 1st Ave NE Shoreline, WA 98155 This document references the following complaint numbers: 120158. The following sample was selected for review during the unannounced on-site visit: 9 of 42 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Faith Le, NCI Erin Steinbrenner, Nursing Consultant Institutional From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 , Unit J 20311 52nd Ave W, Suite 100 Lynnwood, WA 98036 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. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2589 Compliance Determination # 37666 Plan of Correction Aegis Living Callahan House Completion Date Page 5 of 7 Licensee: 15100 1st Ave Shoreline LLC 03/12/2024 Administrator (or Representative) Date WAC 388-78A-2305 Food sanitation. The assisted living facility must: (1) Manage food, and maintain any on-site food service facilities in compliance with chapter 246-215 WAC, Food service; This requirement was not met as evidenced by: Based on observation, interview and record review, the Assisted Living Facility (ALF) failed to have a system in place to ensure ready-to-eat foods were labeled, dated, unexpired, and safe for residents to consume and failed to ensure hot food serving temperatures were maintained at or above 135 Fahrenheit (F) and cold food serving temperatures were maintained at or below 41 degrees F. These failures placed 42 residents at risk for acquiring food-borne illness. Findings included… NOTE: According to the Washington State Food Workers Course at foodworkercard.wa.gov showed cold food should be marked with the date if kept more than 24 hours. All refrigerated food should be served or discarded within seven days after opening. When you open or prepare refrigerated ready to eat food, mark the date immediately. Start with the day you open or prepare the food and add six days. Reference Washington Administrative Code (WAC) WAC 246-215-03525 Temperature and time control—Time/temperature control for safety food, hot and cold holding (Food and Drug Administration ((FDA)) Food Code 3-501.16). (1) Except during active preparation for up to two hours, cooking, or cooling or when time is used as the public health control as specified under WAC 246-215-03530, and except as specified in subsections (2) and (3) of this section, time/temperature control for safety food must be maintained: (a) At 135°F (57°C) or above, except that roasts cooked to a temperature and for a time specified under WAC 246-215-03400(2) or reheated as specified under WAC 246-215-03440 may be held at a temperature of 130°F (54°C) or above; or (b) At 41°F (5°C) or less. Reference WAC 246-215-03526 Temperature and time control—Ready-to-eat, time/temperature control for safety food, date marking (FDA Food Code 3-501.17). (1) Except when PACKAGING FOOD using a REDUCED OXYGEN PACKAGING method as specified under 03540, and except as specified in subsections (5) and (6) of this section, refrigerated, READY-TO-EAT, TIME/TEMPERATURE CONTROL FOR SAFETY FOOD prepared and held in a FOOD ESTABLISHMENT for more than twenty-four hours must be clearly marked to indicate the date or day by which the FOOD must be consumed on the PREMISES, sold, or discarded when held at a temperature of 41ºF (5ºC) or less for a maximum of This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2589 Compliance Determination # 37666 Plan of Correction Aegis Living Callahan House Completion Date Page 6 of 7 Licensee: 15100 1st Ave Shoreline LLC 03/12/2024 seven days. The day of preparation must be counted as day one. (2) Except as specified in subsections (5) through (7) of this section, refrigerated, READY-TO-EAT, TIME/TEMPERATURE CONTROL FOR SAFETY FOOD prepared and PACKAGED by a FOOD PROCESSING PLANT must be clearly marked, at the time the original container is opened in a FOOD ESTABLISHMENT and if the FOOD is held for more than twenty-four hours, to indicate the date or day by which the FOOD must be consumed on the PREMISES, sold, or discarded, based on the temperature and time requirements specified in subsection (1) of this section and: (a) The day the original container is opened in the FOOD ESTABLISHMENT is counted as day one; and (b) The day or date marked by the FOOD ESTABLISHMENT may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on FOOD safety. Review of the undated Resident Characteristic Roster showed the facility provided care and services, including meals to 42 memory care (MC) residents. Seventeen MC residents lived on the Ballard Unit, 15 MC residents lived on the Fremont Unit, and ten MC residents lived on the Queen Anne Unit. Observation and interview, during the environmental tour with Staff A (Administrator) and Staff G (Maintenance Director), on 03/05/2024 at 10:18 AM, showed a refrigerator in the kitchenette area of Queen Anne Unit. Observation of the contents of the refrigerator showed thick white liquid that had been removed from its manufacturing package and stored in a clear plastic bottle had no label or date, and cut fruit and liquid removed from its manufacturing package and stored in a steel quart container had no label or date. Staff A stated the thick white liquid was ranch dressing and the cut fruit was pineapple chunks, and those items should have a label. A refrigerator in the kitchenette area of Fremont Unit showed a plate containing cookies had plastic wrap that was ripped in half placed on top of the refrigerator. Staff A stated the cookies needed to be thrown away. A refrigerator in the kitchenette area of Ballard Unit showed a gallon of milk, half remaining, with an expiration date of March 1 (expired 4 days ago), juice removed from its manufacturing package and stored in a plastic pitcher had no label or date. Observation and interview during lunch service on Queen Anne Unit, on 03/06/2024 at 12:00 PM, showed Staff I (Life Enrichment Assistant) taking the temperature of baked salmon, the temperature was at 125 degrees F. Staff I stated the salmon should be at least 135 degrees F and cannot be served to residents. Observation, record review, and interview during lunch service on Fremont Unit, on 03/06/2024 at 12:08 PM, showed Staff A plating and serving baked salmon and garden salad. The Food Temperature Log (FTL) for Fremont Unit showed the temperature of the salmon had been logged at 138.5 F and the salad had been logged at 42.4 degrees F. Staff A stated the food was temped and logged at around noon before service, and he did not realize the salad did not meet cold holding standards when served to residents. Further observation, at 12:15 PM, showed Staff A taking another temperature reading of the salmon was at 115 degrees F and the salad was at 43 degrees F. Staff A stated he was unsure why the temperature of the salmon had dropped significantly since the initial temperature from the FTL. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2589 Compliance Determination # 37666 Plan of Correction Aegis Living Callahan House Completion Date Page 7 of 7 Licensee: 15100 1st Ave Shoreline LLC 03/12/2024 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, Aegis Living Callahan House 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