Fields Senior Living at Spokane Valley.

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Fields Senior Living at Provider Type: Assisted Living Facility Spokane Valley License/Cert.#: 2669 Intake ID: 206406 Compliance Determination #: 70650 Region/Unit #: RCS Region 1 / Unit B Investigator: Veronica Jackson Investigation Date(s): 12/29/2025 through 01/08/2026 Complainant Contact Date(s): 01/02/2026, 01/29/2026, 12/29/2025 Allegation(s): 1. Residents are not getting safe and appropriate care. 2. Unsafe medication systems. 3. Care plans are outdated and inaccurately describe care needs. 4. Inappropriate level of care. 5. Residents sitting for long periods. 6. Inadequate monitoring of high risk residents. 7. Not enough staff. 8. Not enough staff to pass medications. 9. Training and onboarding is lacking. 10. Staff have to work long shifts. Investigation Methods: Sample: Total residents: 98 Resident sample size: 4 Closed records sample size: 0 Observations: Sample Residents Staff to Resident interactions Residents in common areas Resident Rooms Lunch Service Medication Room Medication Cart Medication Storage and disposal Narcotic medication storage, records and disposal practices. Resident medication administration Resident care Interviews: Administrator Director of Alderbrook Regional Staff Residents Resident representatives Caregivers Med Techs Hospice Nurse This document was prepared by Residential Care Services for the Locator website. Record Reviews: Resident Records Characteristic Roster Facility policy's (multiple) Staff List Sampled Staff Training records Staff Backgrounds Staff fingerprints Staff references checks Investigation Summary: 1. A memory care resident did not receive safe and adequate care. The resident was not assisted as outlined in their negotiated service agreement. Failed practice identified and cited for WAC 388-78A-2160. 2.The facility's medication system and processes were observed and reviewed, and no concerns were identified. The facility's disposal of medication system was appropriate, the narcotic log book was accurate, and the medication ordering process was effective. Staff, resident and resident representative interviews were completed and no medication concerns were expressed. No failed practice identified. 3. Sampled resident care plans were reviewed, and residents and resident representatives were interviewed, and no concerns were noted. Review showed that records were up to date and noted to be accurate. No failed practice was identified. 4. One resident was noted to be found outside after normal business hours, staff observed this and were able to encourage the resident to return to the facility without incident. The facility reported to the department and completed an investigation. The facility implemented measures to decrease the chances of recurrence. The facility's security practices were reviewed and no failed practice was identified. 5. Residents, resident representatives, and staff were interviewed and no concerns were voiced. Observations showed staff were present and available to assist residents when needed. Staff were observed helping residents with transfer and mobility. No failed practice identified. 6. Staffing schedules were reviewed, staff, residents and resident representatives were interviewed and did not identify any substantiated resident care deficiencies. No failed practice identified. 7. Observation showed staff presence and availability. The facility staff schedule was reviewed and an interview with facility administration showed the facility had a plan to increase staffing. Interviews with staff and resident/resident representatives showed that residents received care services with reasonable wait times. Unmet care were not identified as a result of insufficient staff. No failed practice identified. 8. Two medication technicians stated that at times they felt staffing could be improved but denied that medication services were not provided appropriately. Resident medication records were reviewed and no omissions or errors were noted. No failed practice identified. 9. Sampled staff records were reviewed and were noted to be missing orientation, references, and background checks. Failed practice was identified and cited for: WAC 388-78A-2450 (2)(b)(h)(iii)(v) and 388-78A-2466 (1)(a)(b)(2). 10. Not a facility practice. 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 AGING AND LONG-TERM SUPPORT ADMINISTRATION 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 1 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 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 12/29/2025 and 01/08/2026 of: Fields Senior Living at Spokane Valley 16512 E Desmet Court Spokane Valley, WA 99016 This document references the following complaint number(s): 206406 The following sample was selected for review during the unannounced on-site visit: 4 of 98 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Veronica Jackson, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 1 , Unit B 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 2 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 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 388-78A-2160 Implementation of negotiated service agreement. The assisted living facility must provide the care and services as agreed upon in the negotiated service agreement to each resident unless a deviation from the negotiated service agreement is mutually agreed upon between the assisted living facility and the resident or the resident's representative at the time the care or services are scheduled. This requirement was not met as evidenced by: Based on observation, interview and record review, the facility failed to provide the assistance specified in the negotiated service agreement to 1 of 4 residents (Resident 1). This failure resulted in an unmet care need and placed the resident at risk of injury and a decreased quality of life. Findings included… Review of the facility’s Resident Characteristic Roster showed that Resident 1 was admitted on /2024 and resided in the facility’s memory care unit. Further review showed that the resident had dementia (age related cognitive deficits) and required moderate assistance with activities of daily living. Review of Resident 1’s Service Plan Report (SPR, the facility’s titled negotiated service agreement), dated 12/31/2025, showed that the resident required assistance from facility staff with personal hygiene needs and changing their brief. Review of Resident 1’s Progress Notes, dated 12/04/2025, showed that the resident had a fall on 12/04/2025 during the night shift, and appeared to be off balance after that fall on the following day shift. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 3 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 Observation on 01/02/2026 at 12:28 PM showed that Resident 1 was in their room and wore only a shirt and underwear. Observation showed that the resident held a brief in their hand and requested assistance with putting on their brief, from the department licensor. The resident was observed to say, “Can you help me, I don’t know how these work.” Resident 1 was encouraged to request help by pushing their call light. Observation showed that the resident pushed the call light. The department licensor waited outside of Resident 1’s room to observe staff response while also respecting the resident’s privacy. Observation showed that two caregivers and a medication technician walked by Resident 1’s room within the first fifteen minutes and did not answer the call light or enter the resident’s room to help. Observation on 01/02/2026 at 12:45 PM showed that Resident 1 had dressed independently without assistance and that the call light in the resident’s room was still illuminated red, indicating it was still on. In an interview on 01/02/2026 at 12:50 PM, Staff B, Medication Technician, stated that staff were alerted to call lights by the facility phones carried by staff. When asked if their phone showed any call lights on currently, Staff B stated that theirs was charging and not with them. Observation on 01/02/2026 at 1:00 PM, showed Staff A, Director, walked out of Resident 1’s room and had just answered the resident’s call light. In an interview on 01/02/2026 at 1:15 PM, Staff A stated staff had not answered Resident 1’s call light because the staff were not carrying their phones. 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, Fields Senior Living at Spokane Valley 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-2450 Staff. (2) The assisted living facility must: This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 4 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 (b) Verify staff persons' work references prior to hiring; (h) Provide staff orientation and appropriate training for expected duties when staff begin work in the facility, including, but not limited to: (iii) Specific duties and responsibilities; (v) Policies, procedures, and equipment necessary to perform duties; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure staff references were verified before hire for 3 of 8 staff (Staff D, E, and F), failed to provide facility orientation to 4 of 8 staff (Staff C, E, G, and H), and failed to provide job specific orientation to 7 of 8 staff (Staff B, C, E, F, G, H, and J). This failure placed residents at risk of unmet care needs and injury due to receiving care from inadequately trained staff. Findings included… <Reference checks> Review of Staff D’s, Former Resident Care Coordinator, personnel file showed a hire date of 04/30/2025. Further review showed references checks were completed on 01/06/2026, after the employee no longer worked at the facility. Review of Staff E’s, Caregiver, personnel file showed a hire date of 01/28/2025 and that reference checks were not completed until 01/05/2026. Review of Staff F’s, Medication Technician, personnel file showed a hire date of 11/06/2025 and that reference checks were not completed until 01/05/2026. In an interview on 01/08/2026 at 11:05 AM, Staff I, Care and Compliance Specialist, stated that reference checks for Staff D, E, and F had not been completed prior to hire. < Facility orientation> Review of Staff C’s, Medication Technician, personnel file showed a hire date of 05/16/2025 and that facility orientation was not completed until 01/06/2026. Review of Staff E’s personnel file showed a hire date of 01/28/2025 and that facility orientation was not completed until 06/09/2025. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 5 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 Review of Staff G’s, Caregiver, personnel file showed a hire date of 10/07/2025 and that facility orientation was not completed until 01/05/2026. Review of Staff H’s, Caregiver, personnel file showed a hire date of 05/16/2025 and that facility orientation was not completed until 01/05/2026. In an interview on 01/08/2026 at 11:05 AM, Staff I confirmed that facility orientation for Staff C, E, G, and H had not been completed during the new employee orientation period. <Job Specific Orientation Training> Review of the facility’s policy titled, “Staff Training,” dated 07/11/2025, showed that care staff orientation would include job specific duties and responsibilities for providing resident care. The following staff personnel files were reviewed and showed no job specific orientation training: Staff B, Medication Technician, date of hire on 09/08/2023 Staff C, Medication Technician date of hire on 06/16/2025 Staff E, Caregiver, date of hire on 01/28/2025. Staff F, Medication Technician, date of hire on 11/06/2025 Staff G, Caregiver, date of hire on 10/07/2025 Staff H, Caregiver, date of hire on 05/16/2025 Staff J, Medication Technician, date of hire on 10/02/2025 In an interview on 01/08/2026 at 11:05 AM, Staff I confirmed Staff B, C, E, F, G, H and J had not completed job specific orientation training. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 6 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 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, Fields Senior Living at Spokane Valley 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-2466 Background checks Washington state name and date of birth background check Valid for two years National fingerprint background check Valid indefinitely. (1) A Washington state name and date of birth background check is valid for two years from the initial date it is conducted. The assisted living facility must ensure: (a) A new DSHS background authorization form is submitted to the department's background check central unit every two years for all administrators, caregivers, staff persons, volunteers and students; and (b) There is a valid Washington state name and date of birth background check for all administrators, caregivers, staff persons, volunteers and students. (2) A national fingerprint background check is valid for an indefinite period of time. The assisted living facility must ensure there is a valid national fingerprint background check completed for all administrators and caregivers hired after January 7, 2012. To be considered valid, the national fingerprint background check must be initiated and completed through the department's background check central unit after January 7, 2012. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure that a Washington state name and date of birth background check was completed within the required timeframe for 1 of 8 sampled staff (Staff B) and that a national fingerprint background check was completed for 1 of 8 sampled staff (Staff C). This failure placed residents at risk of receiving unsupervised care from potentially disqualified staff. Findings included… Review of Staff B’s, Medication Technician, personnel file showed a hire date of 09/08/2023. Further review showed that a name and date of birth background check was completed on 09/08/2023 and then again on 01/06/2026. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 70650 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 7 of 7 Licensee: Spokane Valley Seniors Housing, LLC 01/08/2026 Review of Staff C’s, Medication Technician, personnel file showed a hire date of 05/16/2025. Further review showed that no national fingerprint background check had been completed. In an interview on 01/08/2026 at 11:00 AM, Staff I, Care and Compliance Specialist, stated that Staff B’s name and date of birth background had expired and that Staff C’s fingerprint check had not been completed. 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, Fields Senior Living at Spokane Valley 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 This document was prepared by Residential Care Services for the Locator website.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Spokane Valley Seniors Housing, LLC Fields Senior Living at Spokane Valley 16512 E Desmet Court Spokane Valley, WA 99016 RE: Fields Senior Living at Spokane Valley License# 2669 Dear Administrator: This letter addresses Compliance Determination(s) 61104 (Completion Date 06/11/2025) and 57483 (Completion Date 04/16/2025). The Department completed a follow-up inspection of your Assisted Living Facility on 06/11/2025 and found no deficiencies. Your facility meets the Assisted Living Facility licensing requirements. The Department found that deficiencies for the following licensing laws and regulations were corrected: WAC 388-78A-2120-4, WAC 388-78A-2120-3-a, WAC 388-78A-2120-1, WAC 388-78A-24701- 1, WAC 388-78A-2660-2, RCW70.129.140.1, WAC 388-78A-2090-6-e, WAC 388-78A-2320-1- b, WAC 388-78A-2320-1-a, WAC 388-78A-2320-1, WAC 388-78A-2710-3-a, WAC 388-78A- 2290-3-a, WAC 388-78A-2290-3-b, WAC 388-78A-2290-3-c, WAC 388-78A-2290-3-d, WAC 388-78A-2290-4, WAC 388-78A-2290-4-a, WAC 388-78A-2290-4-b, WAC 388-78A-2290-4-c, WAC 388-78A-2290-4-d, WAC 388-78A-2620-2-a, WAC 388-78A-2484-1, WAC 388-78A-2484- 2, WAC 388-78A-2484, WAC 388-78A-2610-1, WAC 388-78A-2610-2-a, WAC 388-78A-2100-2- a, WAC 388-78A-2100-2-b-i, WAC 388-78A-2100-2-b-ii The Department staff who did the on-site verification: Joy Pipgras, LTC Surveyor Veronica Jackson, Assisted Living Facility Licensor If you have any questions, please contact me at (509)993-7821. Sincerely, This document was prepared by Residential Care Services for the Locator website. Fields Senior Living at Spokane Valley# 2669 06/11/2025 Page 2 of2 Stephanie Jenks, Community Field Manager Region 1, Unit B Residential Care Services 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 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 1 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 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 on 04/08/2025 and 04/11/2025 of: Fields Senior Living at Spokane Valley 16512 E Desmet Court Spokane Valley, WA 99016 The following sample was selected for review during the unannounced on-site visit: 10 of 66 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Joy Pipgras, LTC Surveyor Jennifer Lee, Assisted Living Facility Licensor Veronica Jackson, Assisted Living Facility Licensor Carla Rose, NCI Community Licensor Abigail Vanderkolk, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 1 , Unit B 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 This document was prepared by Residential Care Services for the Locator website. No. 7902 P. 4 state of lla!ih i ngton Statement of Deficiencies License#: 2669 Compliance D!l1erminatlon # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 2 of 20 Lic~nsae: Spokane Valley Seniors Housing, LLC 04/16/2025 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. Osa4~ 04/29/2025 Re5'ential &are 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 388-78A-2120 Monitoring residents' well-being. The assisted living facility must: (1) Observe each resident consistent with his or her assessed needs and negotiated service agreement: (3) Evaluate, in order to determine if there is a need for further action: (a) The changes identified in the resident per subsection (2) or this section; and (4) Take appropriate action in response to each resident's changing needs. This requirement was not met as evidenced by; Based on observation, interview, and record review, the facility failed to provide treatment for skin concerns for 1 of 9 residents (Resident 2). This failed practice placed the residents at risk of further skin breakdown and medical complications. Findings included ... Review of the most recent characteristic roster provided to the department on 04/08/2025, showed that Resident 2 lived in the memory care unit. Review of Resident 2's Service Plan Report (the facility's negotiated service agreement) dated 02/03/2025, showed that Resident 2 had a diagno-sis of and a history of a reoccurring pressure ulcer on the right buttock. Further review showed their skin care interventions included "[Resident 2] will develop and/or maintain clean and intact skin." This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 3 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 In an interview on 04/09/2025 at 2:10 PM, Staff E, Medication Technician, stated that care staff were to notify the licensed practical nurse (LPN) and the medical provider when a wound or medical concern was discovered. If the LPN was out of the facility, they were to call them and ensure it was documented in the progress notes. <Rash> Review of Resident 2’s progress notes from 01/08/2025 through 04/08/2025 included notes that showed their Volteran gel (medicated gel applied to the skin to reduce inflammation and pain in tendons and joints) was held due to a rash on Resident 2’s arm. The notes were documented as follows: 01/11/2025 at 7:07 PM - “Residents arm had a little bit of a rash, did not apply this topical this evening” 01/12/2025 at 2:47 PM and 5:26 PM - “Resident currently has a rash on [their] arm where we are to apply this medication, I do not want to irritate the skin any further and held this medication this evening” 01/18/2025 at 2:19 PM and 5:21 PM - “Held due to a rash on [their] arm that is healing but I don’t want to irritate it more” 02/20/2025 at 1:00 PM - “has redness to left lower arm that is itchy fax was sent to [their] primary dr” Further review of Resident 2’s progress notes from 02/20/2025 through 04/08/2025, showed no additional notes regarding the condition of the rash. Observation and interview on 04/10/2025 at 9:15 AM, showed Resident 2’s lower left arm had redness and a scaly appearance from their elbow to their wrist. Resident 2 stated their left arm was very itchy. In an interview on 04/09/2025 at 3:30 PM, Staff F, Director of Resident Services/LPN, stated they were unaware of the rash on Resident 2’s arm. <Wound> Review of Resident 2’s progress notes from 01/08/2025 through 04/08/2025 showed the following notes about a wound that was on Resident 2’s buttock: This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 4 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 02/01/2025 at 2:24 PM – “sore on bottom is really bad, and pain to touch” 03/06/2025 at 10:00 PM – “resident has a large and severe sore on right side of [their] bottom, keep an eye to make sure it hasn’t popped and reposition every hour” 03/07/2025 at 11:03 AM – “called home health about resident having a bad sore on right side of bottom” 03/07/2025 at 1:44 PM – “home health called back…on Monday they will come out to see resident” 03/09/2025 at 9:06 PM – “sore on bottom has opened and was bleeding” 03/12/2025 at 11:31 AM – “still having some redness on bottom” Further review of progress notes from 03/12/2025 through 04/08/2025, showed no additional notes to indicate that the wound on Resident 2’s buttocks was further assessed or treated. In an interview on 04/10/2025 at 3:30 PM. Staff F stated that Resident 2 received care from home health for wounds on their heel since February 2025 and the wound on Resident 2’s buttocks was also managed by home health. Review of Resident 2’s home health records dated 03/31/2025, 04/03/2025, 04/07/2025, and 04/10/2025, showed treatment for a heel wound only. Further review showed the home health visits did not include any treatment for the wound on Resident 2’s buttocks. In an interview on 04/11/2025 at 11:30 AM, Staff F stated that they called home health [on 04/11/2025] and confirmed that home health was unaware of the wound on Residents 2’s buttocks, and they had not assessed nor provided care to the buttocks wound during that time. This document was prepared by Residential Care Services for the Locator website. M_~L. ,2: 20 2 5 5: 30 P M No. 7902 P. 7 1 _ 30 _ 2025 state of llilsh in gton 9, Statement of Deficiencies License#: 2689 Compliance Determination# 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 5 of 20 Lic.ensee: Spokane Valley Seniors Housing, LLC 04/16/2025 Plan/Attestation Statemen·t I hereby cerlify that I have reviewed this report and have t.a ken or will take active mea$ures to correct this deficiency. By taking this action, Fields Senior Living at Spokane Valley is or will be in compliance with this law and I or regulation on S/31/cl.aJS . (□at8) In addition, I will implement a system to monitor and ensure continued compliance with this requirement. /5 / ~ ')_o).!j Administrator (or Representative) ~- DateS WAC 388-78A-24701 Background checks Employment Nondisqualifying information. (1.) If the background check results show that an employee or prospective employee has a criminal conviction or pending charge for a crime that is not a disqualifying crime under chapter 388-113 WAC, then the assisted living facility must determine whether the person has the character, competence and suitability to work with vulnerabla -adults in long-term care. This requirement was not met as evidenced by: Based on interview and record review, the facility failed lo complete a character, competence and suitability review after a background check showed a non-disqualifying l!riml! for 1 of 5 staff (Staff C). This failed practice placed residents al risk of receiving care from a potentially unsuitable staff member. · Findings included .. , Review of pensQnnel records showed Staff C, Nurse Assii,tant Certified, was hired on 09/09/2024. The personnel file included a fingerprint background check. completed on 10/04/2024 which showed a history of a criminal charge on their record. Further review showed the pen.onnel file did not contain a character, competence and suitability (CCS) review. As of 04/11/2025, Staff A records did not contain a CCS to determine staff's suitability to work with vulnerable adults. In an interview on 04/11/2025 at 10:35 AM, Staff A, Administrator, stated that a CCS review was not completed for Staff C. This document was prepared by Residential Care Services for the Locator website. No. 7902 P. 8 State of llashington 10, Statement of Deficiencies License#: 2669 Compliance Determination# 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 6 of 20 Lic.ensee: Spokane Valley Seniors Housing, LLC 04/16/2025 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, Fields Senior Living at Spokane Valley is Of will be in compliance with this law and/ or regulation on 515 L'J..oJ.5 . (Date) In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) ~ ~ RCW 70.129.140 Quality of life --Rights. (1) The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of bis or her individuality. WAC 388-78A-2660 Resident rights. The assisted living facility must: (2) Ensure all staff persons provide care and services to each resident consistent with chapter 70.129RCW; This requirement was not met as evidenced by: Based on observation and interview, the facility failed to provide care in a mannet which promoted dignity and resident rights when staff entered resident$ room without knocking for 2 of 9 sampled residents (Resident 8 and 9). This failed practice caused stress for the residents and 11iolated the residents' privacy, Findings included ... Per RCW 70.129.140 Quality of life-Rights, the facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respoact in full recognition of his or her individuality. <Resident 9> Observation and interview on 04/10/2025, at 1;23 PM, showed Resident 9 in their room with the department when Staff H, Caregiver, walked into the resident's room without knocking or being invited in. Resident 9 stated that Staff H has walked into their room without knocking on numerous occasions. Resident 9 further stated that multiple caregivers frequently did not knock, or they knocked, but did not wait for a response prior to entering, a11d that sornetimes the resident was in their bathroom dressing or This document was prepared by Residential Care Services for the Locator website. 1.30.21125May. 5.2025 5:30PM No. 7902 P. 9 state of Wash In gton Statement of Deficiencies License#: 2669 Compliance Determination# 57483 Plan of Correction Fields Senior Living at -Spokane Valley Completion Date Page 7 of 20 Lic.ensee: Spokane Valley Seniors Housing, LLC 04/16/2025 toileting when this had happened, and it made them feel very uncomfortable. <Resident 8> In an interview on 04/10/2025 at 2:20 PM, Resident 8 stated that two nights prior, they went to sleep and woke up to a staff member in their kitchen. Resident 8 said they had not heard anyone knock and had not given permission for anyone to enter, and it scared them. 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, Fields Senior Living at-Spokane Valley is or will be in compliance with this law and / or regulation on (Date)5{J};;!o.;¥ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date WAG 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 eacl:t 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 ~nown behaviors or symptoms of the individual causirig concerri or requiring special care, including: (e) Other safely considerations that may pose a danger to the individual or others, such as use of medical devices or the individual's ability to smoke unsupervised, if smoking is permitted in the assisted iiving facility. This requirement was not met as evidenced by: Based on observation, jnterviaw, and record review the facility failed to complete a safety assessment for a bed cane for 1 of 1 resident (Resident 1). This failure placed the resident at risk of entrapment and harm due to no assessment evaluating the need or risk to the resident. Findings included ... This document was prepared by Residential Care Services for the Locator website. No. 7902 P. I 0 state of ~ashlngton 12, Statement of Deficiencies License#: 2689 compliance Determination# 57483 Pl~n of Correction Fields Senior Living at Spokane Valley Completion Date Page 8 of 20 Lic.ensee: Spokane Valley Seniors Housing, LLC 04/16/2025 Review of Resident 1's Face Sheet showed that the resident admitted on 12024 to the memory care unit with a diagnosis of . Observation on 04/08/2025 at 11 :50 AM, showed Resident 1' s bed had a bed cane. Review of Resident 1's Assessment dated 12/15/2024, showed no completed safety assessment that evaluated. the nee;::J, ·benefits, and risks of th.e bed cane. In an interview on 04/09/2025 at 12:42 PM, Staff A, Administrator, staled they could not lo·cate a safety assessment for Resident l's bed cane. Plan/Attestation Statement i 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, Fields Senior Living at Spokane Valley is or will be in compliance with this law and/ or regµlation on .S(Jl t.lo2 :S . (Date) In addition, I will implement a system to monitor and ensure continued compliance with this r!'!quirement. JwN\ 5/.5 j;;)..JJ.S ~ Administrator (or Representative) Date WAC 388-78A-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursirtg services to any re~iderit. either directly or indirectly, the assisted living facility must: (a) Develop and implement systems that support and promote the safe practice of nursing for Eiach resident; and (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure staff had nurse delegation qualifications when administering delegated medications for 1 of 5 staff (Staff GJ and foili;id to obtain written consents for nurse delegation for 2 of 4 residents (Resident 2 and 3). This failure resulted in residents receiving delegated medications they may not have. .CQnsented tp and from staff that had not met qu-'lifications to provide ctelegatec( medications, This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 9 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 Findings included… Per WAC 246-840-930: criteria for nurse delegation, before delegating a nursing task, the registered nurse delegator: -(5) Assesses the ability of the nursing assistant (NA) or home care aid (HCA) to competently perform the delegated nursing task in the absence of direct or immediate nurse supervision. -(8) Verify that the nursing assistant or home care aide: -(8)(a) Is currently registered or certified as a nursing assistant or home care aide in Washington state without restriction; -(10) If the registered nurse delegator determines delegation is appropriate, the nurse: (10)(a) Discusses the delegation process with the patient or authorized representative, including the level of training of the nursing assistant or home care aide delivering care. -(10)(b) Obtains written consent. Verbal consent may be acceptable if written consent is obtained within 30 days. <Consents> Resident 2 Review of Resident 2’s Nurse Delegation Nursing Visit form dated 02/28/2025, showed that Resident 2 required nurse delegation services for all medications. Review of Resident 2’s Nurse Delegation Consent Form, showed a verbal consent was obtained on 03/01/2025. Further review showed that the document did not contain written consent. In an interview on 04/11/2025 at 3:00 PM, Staff I, Resident Care Coordinator, confirmed that they did not obtain written consent for Resident 2. Resident 3 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 10 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 Review of Resident 3's Nurse Delegation Nursing Visit form dated 02/28/2025, showed that Resident 3 received nurse delegation services for all medications. Review of Resident 3’s March 2025 and April 2025 medication administration records (MARs), showed Staff G, had administered Resident 3’s medications on 19 days in the month of March and 3 days in the month of April. Review of Resident 3's nurse delegation consent form showed that written consent was obtained on 04/11/2025 by the residents' representative. In an interview on 04/11/2025 at 3:00 PM, Staff I stated that they had previously obtained written consent for Resident 3, but they could not locate the signed form. Staff I further stated they obtained a signature on a new consent form “today”. <Staff Delegation> Review of the facility's staff list dated 04/08/2025 showed Staff G's date of hire was 01/19/2025. Review of the department of health's provider credential search results on 04/16/2025 showed that Staff G's Home Care Aide Certification had expired on 05/14/2021. Review of Resident 2’s March 2025 and April 2025 medication administration records (MARs), showed Staff G, had administered Resident 2’s medications on 19 days in the month of March and 3 days in the month of April. Review of Resident 2’s Nurse Delegation Nursing Visit form, dated 02/28/2025 showed that Staff G, Medication Technician, was not included on the list of delegated staff that were qualified to administer delegated medications. In an interview on 04/11/2025 at 2:45 PM, Staff A, Administrator, stated that Staff G did not have the qualifications to be delegated, and they should not have administered delegated medications. This document was prepared by Residential Care Services for the Locator website. 1,30,2025May. 5.2025 5:30PM No. 7902 P. 13 State of Washington 16, Statement of Deficiencies License #: 2669 Compliance Determination# 57483 Plan of Correction Fields Senior Lilling at ·Spokane Valley Completion Date Page 11 of20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 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, Fields Senior Living at Spokane Valley is or will be in compliance with this law and/ or regulation on (DateJS/3 i /;J..nJ 5 . In addition, I will implement a system to monitor and ensure continued compliance wi.th this requirement. Administrator (or Representative) ~- ~ DateG/s/JoQ5 WAC 388-78A-2710 Disclosure of services. (3) The assisted living facility must provide a minimum of thirty days written notjce to the residents and the residents' representatives, if any: (a) Before the effective date of any decrease in the scope of care or services provided by the assisted living facility, due to circumstances beyond the assisted living facility's control; and This requirement was not met as evidenced by: Based on interview and record review, the facility failed to update a decrease in nursing services hours on 1 of 1 document (di$cJosure of $E!rvices). Thi$ failure resulted in residents and representatives not being aware of or informed of the decreased service hours. Findings Included ... Review of the facility's undated Disclosure of Services showed that the facility offered Registered Nurse (RN) services 40 hours a week, and Licensed Practical Nurse {LPN) servicas 168 hours a week. Further review showed the signature of a prior administrator. Review of an undated staff list showed no RN on staff and one LPN 40 hours a week. In an interview on 04/10/2025 ,it2:31 PM, Staff A, Administrator, sfated that the previoljs RN gave a 30-day notice, ani:t that their last day of employment was 02/12/2025. Staff A, further stated that were not going to hire an RN until the facility was at 80% capacity and that no 30-day notification with the decrea!;e in nursing hours had been provided to any residents or their representatives and confirmed that the facility C1,Jrrenlly had or.,e LPN at 40 hours a week, This document was prepared by Residential Care Services for the Locator website. 1.:10.z 25Ma 5. 2025 5:31PM No. 7902 P. 14 0 State of ~ashlngton 16, Statement of Deficiencies License #: 2669 Compliance Determination# 57483 Plan of Correction Fields Senior Lilting at -Spokane Valley Completion Date Page 12 of20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 In an interview on 04/10/2025 at 2:35 PM Staff A stated that a Disclosure of Services was provided to each resident upon admission. Staff A further confirmed that residents who were admitted after 02/12/2025 received a Disclosure of Services with inaccurate information regarding nursing service hours. Plan/Attestation State·ment I hereJ;ly certify that I have reviewed this report and have taken or will lake active measures to correct this deficiency. By taking this a_ction, Fields Senio_r Living at Spokane Valley is or will be in c.ompliance with this law and/ or regulation on /51/;J,t:1 lS (Date)S In i:lddilion, I will implement a system to monitor and ensure continued compliance with this requirement. ~ ~ Al\ ' Administrator (or Representative) Date WAC 38B-78A-2290 Family assistance with. medications and treatments. (3) If the assisted living facility allows family assistance with or administration of medicaticms and treatments, ano the resident and a Family member(s) agree a family member will provide medication or treatment assistance, or medication or treatment administration to the resident, the assisted living facility must request that the family member submit to the assisted living facility a written plan for S\.lCh assistance or administration that includes at a minimum: (a) By name, U,e family member who will provide the medication or treatment assistance or administration: (b) A description of the medication or treatment assistance or administration that the family member will provide, to be referred to as the primary plan; (c) An alternate. plan if the family member is unable to fulfill his or her duti&s as specified in the primary plan; (d) An emergency contact person and telephone number if the assisted living facility observes change$ in the resident's overall functioning or condition that may relate to the medication or treatment plan; ;,ind (4) The plan for family assistance with medications or treatments must be signed and dated by: (a) The resident, if able; (bl The resident's representative. if any; (c) The resident's family member responsible for implementing the plan; and (d} A representative of the assisted living facility authorized by the assisted living facility to sign on its behalf. This document was prepared by Residential Care Services for the Locator website. 1.J0.2025May. 5. 2025 5:31PM No. 7902 P. 15 State of Washington 17, Statement of Deficiencies License#: 2869 Compliance Determination# 57483 Plan of Correction Fields Senior Living at -Spokane Valley Completion Date Page 13 of20 Licensee; Spokane Valley Seniors Housing, LLC 04/16/2Q25 This requirement was not met as evidenced by: Based on interview and record review, the facility failed to obtain a family assistance with medications plan for 1 of 1 resident ·(Resident 7). This failure placed Resident 7 at risk of not receiving medications as ordered or medical supplies as needed, if family were unable to provide them. Findings included,., Review of Resident 7's Face Sheet showed they were admitted on /2023 with a diagnosis of and . Review of Resident Ts Level of Care and Service Plan (facility's assessment and negotiated service agreement), updated 03/04/2025, stated that the resident required assistance with medication administration, ordering medications, communication with the pharmacy, and that supplies [for over the-counter (OTC) medications and diabetic medications] were provided by the family. Review of Resident 7's undated medical chart did not contain a written and signed family assistance with medication r,lan to ensure there was a system in place for the resident to receive OTC medications and diabetic supplies. In an interview on (}4/10/2025 at 1:47 PM, Staff A, Administrator, stated they did not have a written or signed family plan to assist Resident 7 with obtaining medication and supplies. 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, Fields -Senior Living at Spokane Valley is or will be in compliance with this law and I or regulation on I J.-~;;J,,5 , - (Date)S/31 In addition, I will implement a system to monitor and ensure continued compliance with !his requirement. 5 / S /,) (12,5 Admii1istrator (or Representative)~~ Date This document was prepared by Residential Care Services for the Locator website. 1.J0.2025May. 5. 2025 5:31PM No. 7902 P. 16 state of llash In gton 18, Statement of Deficiencies License #: 266 9 Compliance Determination# 57483 Plan of Correction Fields Senior Living at -Spokane Valley Completion Date Page 14 of20 Lic.ensee: Spokane Valley seniors Housing, LLC 04/16/2025 WAC 388-78A-2620 Pets. ff an assisted living facility allows pets to live on the premises, the assisted living facility must: (2) Ensure animals living on the assisted living facility premises: (a) Have regular examinations and immunizations, appropriate for the species, by a veterinarian licensed in Washington state; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure pets had current vaccinalions for 4 of 9 resident pets (Pets 1, 2, 3, and 4). This failure place(! 'resii:lents at risk of cont.act from unvaccinated animals. Findings included ... Review of Pet 1's pet records showed no examination or vaccination records. Review of Pet 2's pet records showed no examination or vaccination records. Review of Pet 3's pet records s;howed no examination or vaccination records. In an interview on 04/11/2025 at 2:14 PM, Staff A, Administrator, stated that they did not have current vaccination records for Pets 1, 2, 3, and 4. Pl an/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to e0rrect this deficiency. By taking this action, Fields Senior Living at Spokane Valley is or w_ill be in compliance with this law and/ or regulatjon on (Date).$1~1 /:J,oJ, ,$ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date WAC 388-78A-2474 Training and home care aide certification requirements. (2) The assisted living facility must ensure all assisted living facility administrators, or their designees, and caregivers hired on or after January 7, 2012 meet the long•lerm care worker training requirements of chapter 388-112A WAC, including but not limited This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 15 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 to: (d) Cardiopulmonary resuscitation and first aid; and This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure that facility orientation training was completed by 1 of 5 staff (Staff C), and failed to ensure cardiopulmonary resuscitation and first aid certification training was obtained by 1 of 5 staff (Staff B). These failures placed residents at risk of receiving care from untrained facility staff. Findings included... Review of WAC 388-112A-0200 (1) Facility orientation. Individuals who are exempt from certification as described in RCW 18.88B.041 and volunteers are required to complete facility orientation training before having routine interaction with residents. This training provides basic introductory information appropriate to the residential care setting and population served. The department does not approve this specific orientation program, materials, or trainers. No test is required for this orientation. <Staff B> Review of Staff B’s, Medication Technician, personnel records showed a hire date of 01/23/2025. Further review showed no documentation that cardiopulmonary resuscitation (CPR) and first aid training had been completed. In an interview on 04/11/2025 at 10:45 AM, Staff A, Administrator, stated they could not locate any CPR and first aid training for Staff B. Review of the March 2025 and April 2025 staff schedule showed that Staff B worked on 03/23/2025, 03/30/2025, and 04/06/2025. <Staff C> Review of Staff C’s, Nurse Assistant Certified, personnel records showed a hire date of 09/09/2024 and did not contain any records for the facility orientation. In an interview on 04/11/2025 at 12:09 PM, Staff A stated they could not locate any facility orientation training records for Staff C. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 16 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 WAC 388-78A-2484 Tuberculosis Two step skin testing. Unless the staff person meets the requirement for having no skin testing or only one test, the assisted living facility choosing to do skin testing, must ensure that each staff person has the following two-step skin testing: (1) An initial skin test within three days of employment; and (2) A second test done one to three weeks after the first test. This requirement was not met as evidenced by: Based on observation and record review, the facility failed to ensure staff received tuberculosis two step testing for 3 of 5 sampled staff (Staff B, C, and D). This failure placed residents at risk of exposure to a communicable disease. Findings included… <Staff B> Review of personnel records for Staff B, Medication Technician, showed they were hired on 01/23/2025. Further review showed the file did not contain any records of tuberculosis (TB, a communicable respiratory disease) testing. In an interview on 04/11/2025 at 10:45 AM, Staff A, Administrator, stated they could not locate any TB testing result records for Staff B. <Staff C> Review of personnel records for Staff C, Nurse Assistant Certified, showed they were hired on 09/09/2024. Further review showed the file did not contain records of any TB testing. In an interview on 04/11/2025 at 12:00 PM, Staff F, Director of Resident Services, stated that they did not have any records of TB testing for Staff C. <Staff D> Review of personnel records for Staff D, Medication Technician, showed they were hired on 08/13/2024. Further review showed the file did not contain any records of TB testing. In an interview on 04/11/2025 at 10:45 AM, Staff A, stated they did not have any TB This document was prepared by Residential Care Services for the Locator website. 1 . 30 . 2025 Ma 5. 2025 5:31PM state of Washington No. 7902 P. 19 21, Statement of Deficiencies License #: 2669 Compliance Determination# 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 17 of20 Lic.ensee; Spokane Valley Seniors Housing, LLC 04/16/2025 tasting result records for Staff D. PlantAttestation 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, Ffelds senior LMng at Spokane wm Valley is or be in compliance with this law and/ or regulation on (Date) 5 l!i 111:,0;;i,s . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date WAC 388-78A-2610 Infection control. (1) The assistl'!d living facijlity must institute app~priall'! infection control practices in the assisted living facility to prevent and limit the spread of infections. (2) The assisted living fat:ility must: (a) Develop and implement a system to identify and manage infections; This requifem"ent was not met as evidenced by: Based on record review and interview, the facility failed to perform annual N95 respirator flt testing when 1 of 1 re$icjent (Re$ident 10) tested positive for Covid 19 for 5 of S staff (Staff A, 8, C, D, and E). This failure placed residents and staff at risk of contracting and spreading infections when a resident recently tested positive for Covid 19. Findings included ... Center for Disease Control (CDC) stated when implementing Transmission Based Precautions/Airborne Precautions required to reduce the spread of Covid 19 (Coronavirus Disease, a contagious respiratory virus), the CDC recommended healthcare personnel use a National Institute for Occupational Safety and Health (NIOSH) approved, flt-tested respirator (N95) for all encounters of suspected or confiniled airborne illnesses that could spread when an infected person coughed, sneezed, or spoke. Fit testing is an activity where the seal of a respirator is tested to determine if it's adequate and is required to be completed annually to ensure continued effectiveness. Review of Resident 10's progress notes showed that on 04/09/2025 the resident was sent lo the hospital and tested positive for Covld 19. The progress notes further showed that the resident was quarantined in their room and staff placed a personal protective This document was prepared by Residential Care Services for the Locator website. 1.31l.2025May. 5. 2025 5:31PM State of Mashlngton No. 7902 P. 20 22, Statement of Deficiencies License#: 2669 Compliance Determination# 57463 Plan of Correction Fields Senior Li\/ing at Spokane Valley Completion Date Page 18 of 20 Lic.ensee: Spokane Valley Seniors Housing, LLC 04/16/2025 equipment (PPE) cart outside their door. In an interview on 04/11/2025 i'lt 10:50 AM, Staff K, Medication Technician. stated that Resident 10 recently tested positive for Covld, and that staff put on PPE prior to providing care for the resident. When questioned further, Staff K stated the PPE included gowns, gloves, shields and N95 mas.ks. Review of Staff A's, Administrator, persor1nel record showed a hire date of 02/16/2025. Further review showed that no fit testing had been completed. Review of Staff B's, Medication Tec:hnician, personnel record showed a hire date of 01/23/2025. Further review showed that no fit testing had been completed. Review of Staff C's, Nursing Assistant Certified, personnel record showed a hire date of 09/09/2024. Further review showed that no fit testing had been completed. Review of Staff D's, Medication Technician, personnel record showed a hire date of 08/13/2024. Further review showed that Staff D completed the medical release for FIT testing on 02/28/2024, but no fit testing had been completed. Review of Staff E's, Medication Technician, personnel record showed a hire date of 02/24/2026. Further review showed. that no fit testing had been completed. In an interview on 04/11/2025 at 1:38 PM, Staff A, Administrator, stated that the facility did not have any records of fit testing that had been completed since March of 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, Fields Senior Living at Spokane Valley is or will be in compliance with this law and / or regulation on /alJ )5 . (Date).5./,3 / In addition, I will implement a system to monitor and ensure continued compliance with this requirement. ~ ~ DateS/S/JoJS Administrator (or Representative) This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 57483 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 19 of 20 Licensee: Spokane Valley Seniors Housing, LLC 04/16/2025 WAC 388-78A-2100 Ongoing assessments. (2) The assisted living facility must: (a) Complete a full assessment addressing the elements set forth in WAC 388-78A-2090 for each resident at least annually; (b) Complete an assessment specifically focused on a resident's identified problems and related issues: (i) Consistent with the resident's change of condition as specified in WAC 388-78A-2120 ; (ii) When the resident's negotiated service agreement no longer addresses the resident's current needs and preferences; This requirement was not met as evidenced by: Based on observation, interview, and record review the facility failed to complete an on-going safety assessment for a bed cane for 1 of 1 resident (Resident 1). This failure placed the resident at risk of entrapment and harm due to no assessment evaluating the need or risk to the resident. Findings included… Review of Resident 1’s Face Sheet showed that the resident admitted on /2024 to the memory care unit with a diagnosis of . Observation on 04/08/2025 at 11:50 AM, showed Resident 1’s bed had a bed cane. Review of Resident 1’s Assessment dated 12/15/2024, showed no completed safety assessment that evaluated the need, benefits, and risks of the bed cane. In an interview on 04/09/2025 at 12:42 PM, Staff A, Administrator, stated they could not locate a safety assessment for Resident 1’s bed cane. This document was prepared by Residential Care Services for the Locator website. Ma 5. 20 2 5 5: 31 PM No. 7902 P. 22 _ _ 130 2025 state of llashington 24, statement of Deficiencies License#: 2669 Compliance Determination # 5 7 483 Pliln of Correction Fields Senior Living at Spokane Valley Completion Date Pags20 of 20 Lic.ensee: Spokane Valley Seniors Housing, LLC 04/16/2025 Plan/Attestation Statement I hereby certify that I have reviewed this repoct and have taken or will take active measures to correct this deficiency. By taking this ac:lion, Fields Senior Living at Spokane Valley i,§ gr will be in compliance with this law and / or regulation on /J..d)..~ . (Date)!.:>/'.pl In addition, I will implement a system to monitor and ensure continued compliance wi.th this requirement. /5, Administrator (or Representative) ~ ~ Date 5, j ;Jo ;;._s' 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. Residential Care Services Investigation Summary Report Provider/Facility: Fields Senior Living at Provider Type: Assisted Living Facility Spokane Valley License/Cert.#: 2669 Intake ID: 172666 Compliance Determination #: 56659 Region/Unit #: RCS Region 1 / Unit B Investigator: Sandra Fast Investigation Date(s): 03/20/2025 through 04/01/2025 Complainant Contact Date(s): 03/20/2025 Allegation(s): 1. Nurse with invalid licensure 2. Background checks not completed Investigation Methods: Sample: Total residents: 78 Resident sample size: 5 Closed records sample size: 0 Observations: esidents Dining Resident rooms Staff to resident interactions Resident to resident interactions Medication administration Kitchen Interviews: Nursing staff Residents Kitchen staff Record Reviews: Medical records Facility policies Staff training records Personnel files Investigation Summary: 1. The indicated nurse interviewed stated that they had worked at the facility for two weeks and a few days. Personnel records reviewed showed that the nurse did not have a valid Washington state license until 03/25/25. The resident care coordinator interviewed stated that the identified nurse’s hire date was 03/03/25. Failed facility practice was identified, and a citation was issued according to Washington administrative code (WAC) 388-78A-2450(2)(c). 2. The facility had a process for assuring that staff background checks were valid and up to date. Personnel records reviewed showed that sampled staff had valid background checks that were current. The executive director interviewed stated This document was prepared by Residential Care Services for the Locator website. that all staff were required to have valid background checks in good standing before they were hired. No failed facility practice was 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 AGING AND LONG-TERM SUPPORT ADMINISTRATION 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2669 Compliance Determination # 56659 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 1 of 3 Licensee: Spokane Valley Seniors Housing, LLC 04/01/2025 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 an unannounced on-site complaint investigation on 03/20/2025 of: Fields Senior Living at Spokane Valley 16512 E Desmet Court Spokane Valley, WA 99016 This document references the following complaint number(s): 170549, 169969, 172666 The following sample was selected for review during the unannounced on-site visit: 5 of 78 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Sandra Fast, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 1 , Unit B 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 56659 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 2 of 3 Licensee: Spokane Valley Seniors Housing, LLC 04/01/2025 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 388-78A-2450 Staff. (2) The assisted living facility must: (c) Verify prior to hiring that staff persons have the required licenses, certification, registrations, or other credentials for the position, and that such licenses, certifications, registrations, and credentials are current and in good standing; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure that a staff license was current for 1 of 4 staff (Staff B). This failure resulted in residents receiving care from an individual who did not have current licensure and placed residents at risk for unmet care needs. Findings included… Review of personnel records for Staff B, Licensed Practical Nurse (LPN), showed that they had an active single state LPN license in another state. Further review of Staff B’s records showed that Staff B did not have a current Washington state LPN license in good standing until 03/25/2025. In an interview on 03/20/2025 at 10:06 AM, Staff B stated that they were the Director of Resident Services for the facility and that they had started working at the facility on 03/03/2025. In an interview on 04/01/2025 at 3:37 PM, Staff A, Interim Executive Director, stated that Staff B’s hire date was 03/03/2025. Staff A stated that they thought that it was fine This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 56659 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 3 of 3 Licensee: Spokane Valley Seniors Housing, LLC 04/01/2025 for Staff B to work with a pending status on their license. 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, Fields Senior Living at Spokane Valley 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 This document was prepared by Residential Care Services for the Locator website.

This document was prepared by Residential Care Services for the Locator website. ·~" isse STATE: OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALT H SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 8517 E Trent Ave, Ste 102, Spoka.ne Valley, WA 99212 03/31/2025 Spokane Valley seniors Housing, LLC Fields Senior Living at Spokane Valley 18512 E Desmet Court Spokane Valley, WA 99016 RE: Fields Senior Living at Spokane Valley # 2889 Dear Administrator: This letter addresses deficiencies occurring in the report(s) for: Compliance Determination{s) 57288 (Completion Date 03/31/2025} and 55570 (Completion Date 03/04/2025}. The Department completed a follow-up inspection of your Assisted Living Facility on 03/31/2025 and found no deficiencies. The Department found that deficiencies for the following licensing laws and regulations were corrected: WAC 388-78A-2320 Intermittent nursing services systems. (2) The assisted living facility providing nursing services, either directly or indirectly, must ensure that the nursing services systems include: (b) Nurse delegation, if provided; {3) The assisted living facility must ensure that all nursing services, including nursing supervisi.on, assessments and delegation, are provided in accordance with applicable statutes and rules 1 1 including, but not limited to: (c) Chapter 248-840 WAC, Practical and registered nursing; The Department staff who did the On Site verification: Anne Sinclair, NCI Community Complaint Investigator Abigail Vanderkolk, Community Complaint Investigator If you have any questions, please contact me at (509)993-7821. Sincerely, This document was prepared by Residential Care Services for the Locator website. ~.~~ Stephanie Jenks, Community Field Manager Region 1, Unit B Residential Care Services Residential Care Services Investigation Summary Report Provider/Facility: Fields Senior Living at Provider Type: Assisted Living Facility Spokane Valley License/Cert.#: 2669 Intake ID: 168318 Compliance Determination #: 55570 Region/Unit #: RCS Region 1 / Unit B Investigator: Anne Sinclair Investigation Date(s): 02/27/2025 through 03/04/2025 Complainant Contact Date(s): Allegation(s): 1. No Nurse Delegation. 2. Falsifying resident documents. Investigation Methods: Sample: Total residents: 69 Resident sample size: 8 Closed records sample size: 0 Observations: Residents Dining Activities Staff to resident interactions Resident to resident interactions Interviews: Residents Caregiver Three Medtechs Administrator Resident Care Coordinator Dining Director Resident Representatives Record Reviews: Sample resident care plan/face sheet/Medication Administration Record(January 2025-Current) Disclosure of Services Characteristic roster Staff roster Abuse/neglect reporting policy Facility medication Administration policy Nurse delegation facility incident timeline Nurse delegation policy Investigation Summary: 1. Interview and record review showed facility did not have current Nurse Delegation oversight for resident medications requiring nurse delegation. Citation This document was prepared by Residential Care Services for the Locator website. WAC 388-78A-2320(3) Intermittent Nursing Service Systems, 2. Staff interviewed reported no concerns or directions given by administrative staff related to asking staff to falsify resident documentation. Staff stated they would notify the department if they were asked to falsify documents related to resident care, and were knowledgeable of abuse/neglect reporting process. Residents interviewed had no concerns with staff, felt safe, and can talk to staff about concerns. Record review showed resident care needs were reflected in negotiated service planning. Residents were observed without distress or unmet health needs, and staff were assisting residents during unannounced facility visit. No failed practice. 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. Ii □ □ STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2669 Compliance Determination # 55570 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 1 of 5 Licensee: Spokane Valley Seniors Housing, LLC 03/04/2025 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 an unannounced on-site complaint investigation on 02/27/2025 of: Fields Senior Living at Spokane Valley 16512 E Desmet Court Spokane Valley, WA 99016 This document references the following complaint number(s): 167251, 168318 The following sample was selected for review during the unannounced on-site visit: 8 of 69 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Anne Sinclair, NCI Community Complaint Investigator Abigail Vanderkolk, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 1 , Unit B 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. :.13.2025 13:48:03 State of Washington Stat~ma-nt 9-f DefidB:ncies Lk.ense #: 2669 Gc,mp~fonc:s Oetermrnfi!it.~~n #555TO Pi~m: ,:yf Corr~•G.tfor~ fiBc!ds 8Emit)r U\,.~ng @t Spi')k~tH¼ \/aH9i/ Cu,np}Htbn Lhatti Page 2 uf5 Lkense&-: Epok:ane \/a!Je:y SJ:::nfows Hnu;inft LLC 0.3itf4/202S l.t..s ~ resu~t of the on-sfb~ visit(g)" the· riepattrrH~nt found that '/OU are not in c:nrnp!~ance \'Vittt the !1f.::unslng favv£ ~rHll r~gHlatitH't:jj r:15· stiteti in the c.it:fri d~f~c.i~t:d~s ~n thee: -enl~.kts~d f'frP c:rt. 03/13/2025 I rnider~trtnc.1 that to rTmintaln ~n Assister.:t Uvin~] Fat.i~il:l tk.en~e-, the fr~cHftv rnust be in ;::orr~ptanc0 -w~th al~ the hcensint} !:av..,,s and reg~J~11tions at ;aH hn1et;_ [2) Th~l assisted li\•·inJ ft~~c-ifay f.H'tJVid~n~~$ nurs~r~g SfH\.,,.iCH-s, eitbfctr dir~~:t~y rt.f in:dinKt~~: rriust en-sure thtlt the nurs:ing services sy-sterns in.dude: (:J) TI~e.: assisted !~ving fad~i~v· rm..ttt ensure t~iat aH nursin~J s.ervkes, indu:ding tH. .f fsinti sup1;:,n.ljsku1~ assessrt:ents:: a:nd ddegaho,n, are ~H'(r\.•·:ided fr~ as:cordanc-e 'y\~Rh appfo:abie statutes arsti n..1/e·s'. induding, but not limited t,r. This requirement was net met as evidenced by: Bau~ed n:n in-t-eriiet.-v and rec{JIT~ re'l•ie\A( the f~cWty"faH-:!d to ~ri::sure:~ that nlws-:1~ dc11.:~g~h:!d tasxs vier~ p-e~f~xn1:ed b'/ quaWl@i) and trak1ed s-h~fffor 3 ~,f 3 st~ft (St;;.~ff C~ D~ E) v-~t'lk·h irnpa~:t~d B of 8 san~pted resN:ients {f.;:e:sk1ents ·t .. 2, 3" 4, 6: 6). Trns 'fa~!ure r1~aeed reskierits itlt rksk for rnecik:e.boi:l f!rrors. due to rece~·kig ::are frorn untrained st~ff. In ~ntcrvk:\·\'. on U2l27t2024 '-1t 8:-4D.Af111i, Stuff ..~ (E.Ke~ufri,/1~ Dtre:.:tor) stated that the hK~Hl·y- c.urrent~y ht.ld ~HJ n:ur~e ciel~g,ation o,iers~aht for staff r~late:ti t-o re:sfrJ~nt rrw-tlkaHtu·-·1t> reqt~idng n:urge deh~~-ation., and that staff had been -c.::o-ntinuing tc f.Hlrn~niste:r rnedf:catiuns requ~ring nurse de~egation o\,'$Jt"$:ight tn n~sid~·ntn .. r.::.~~vie1t:i cl a ct-oc:urnent: un:tfate:d~ show--e-d that Staff B {Resident CarE~ (\;ordinator} had d~sc0·1;/ered u--~e- on 02.ll4l20-2f that fad:~ity rl:ld net ~1-ave a: (:urn~nt nurse ddetJat(lr for the faClH~\{I and t~ad a~erter~ Staff A Statement of Deficiencies License #: 2669 Compliance Determination # 55570 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 2 of 5 Licensee: Spokane Valley Seniors Housing, LLC 03/04/2025 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 388-78A-2320 Intermittent nursing services systems. (2) The assisted living facility providing nursing services, either directly or indirectly, must ensure that the nursing services systems include: (b) Nurse delegation, if provided; (3) The assisted living facility must ensure that all nursing services, including nursing supervision, assessments, and delegation, are provided in accordance with applicable statutes and rules, including, but not limited to: (c) Chapter 246-840 WAC, Practical and registered nursing; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure that nurse delegated tasks were performed by qualified and trained staff for 3 of 3 staff (Staff C, D, E) which impacted 6 of 8 sampled residents (Residents 1, 2, 3, 4, 5, 6). This failure placed residents at risk for medication errors due to receiving care from untrained staff. Findings included… In interview on 02/27/2024 at 9:40AM, Staff A (Executive Director) stated that the facility currently had no nurse delegation oversight for staff related to resident medications requiring nurse delegation, and that staff had been continuing to administer medications requiring nurse delegation oversight to residents. Review of a document, undated, showed that Staff B (Resident Care Coordinator) had discovered on 02/14/2025 that the facility did not have a current nurse delegator for the facility and had alerted Staff A. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 55570 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 3 of 5 Licensee: Spokane Valley Seniors Housing, LLC 03/04/2025 In an interview on 02/27/2025 at 11:20AM, Staff D (Medication Tech), stated that since hire, they had not received training, or a competency check with a facility nurse delegator. In an interview on 02/27/2025 at 11:30AM, Staff E (Medication Tech), stated that since hire, they had not received training, or a competency check with a facility nurse delegator. In an interview on 02/27/2025 at 12:20PM, Staff C (Medication Tech), stated that since hire, they had not received training, or a competency check with a facility nurse delegator. <Residents> Review of Resident 1’s Negotiated Service Agreement, dated 01/02/2024, showed that they had a diagnosis of and required staff assistance with medication management and blood glucose checks. Review of Resident 1’s Medication Administration Records, dated 01/01/2025 to 02/27/2025, showed that facility staff documented as providing blood glucose testing (finger poke), a nurse delegated task, once daily for Resident 1. In interview on 02/27/2025 at 12:34 PM, Resident 1 stated that they are not independent with medications, and that staff assist to poke their finger once daily for blood glucose testing. Review of Resident 2’s Negotiated Service Agreement, dated 11/25/2024, showed that they had a diagnosis of and required staff assistance for medication management. Review of Resident 2’s Medication Administration Records, dated 01/01/2025 to 02/27/2025, showed that facility staff documented as providing blood glucose testing (finger poke), a nurse delegated task, once daily for Resident 2. In interview on 02/27/2025 at 1:20 PM, Resident 2 stated they are not independent with medications, and that staff poke their finger once daily for blood glucose testing. Review of Resident 3’s Negotiated Service Agreement, dated 07/08/2024, showed that This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2669 Compliance Determination # 55570 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 4 of 5 Licensee: Spokane Valley Seniors Housing, LLC 03/04/2025 they had a diagnosis of , and required assistance with Medication management. Review of Resident 3’s Medication administration records, dated 01/01/2025 to 02/27/2025, showed that facility staff documented instilling eye drops, a nurse delegated task, twice daily for Resident 1. Review of Resident 4’s Negotiated Service Agreement, dated 09/05/2025, showed that they had a diagnosis of , and required assistance with medication administration. Review of Resident 4’s Medication Administration Records, dated 01/01/2025 to 02/27/2025 showed that facility staff documented instilling eye drops, a nurse delegated task, twice daily for Resident 4. Review of Resident 5’s Negotiated Service Agreement, dated 07/08/2024, showed that they had a diagnosis of , and required Nurse delegation and assistance with medication administration. Review of Resident 5’s Medication Administration Records, dated 01/01/2025 to 2/27/2025, showed that facility staff documented applying prescribed crème once daily and prescribed gel twice daily, nurse delegated tasks, for Resident 5. Review of Resident 6’s Negotiated Service Agreement, dated 10/24/2024, showed that they had a diagnosis of , and required nurse delegation for medication management. Review of Resident 6’s Medication Administration Records, dated 01/01/2025 to 02/27/2025 showed that facility staff documented instillation of eye ointment and eye drops three times daily, and application of topical medication three times daily, nurse delegated tasks, for Resident 6. In interview on 03/04/2025 at 11:55 AM, Staff A stated that the newly hired nurse delegator for the facility had been at the facility on 02/28/2025 and 03/03/2025 to establish current nurse delegation for staff at the facility. Review of facility documents titled Nurse Delegation: Credentials and Training Verification, dated 02/28/2025 and 03/3/2025, showed that Nurse Delegation had been established at the facility for qualified staff beginning on 02/28/2025. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. I, 13.2025 13:48:03 State of Washington St&tttrfl'B-~t !Df Oef1d-B:ndes Pfam i).f C ( Jrfe~~fa)n fi1~!ds $,:minr U~{~ng ,at Sp,ok~:1~ \/~;iJi~f C~rnp-1-:sfaJ;i"l Dt~ti:~ Pag.9: 6 uf 5 u~ens?.e: Spuk~~e 'Vhltey Senbrs Hnuting .. LLC 03/0-4/2026 Plan/Attestation Statement I hert:h'{ eedJ~l that" I have rev~m!<H?.d this rer.,Grt and have t11h:en or \•vi~i take .acti•/e n1c~s:ures to correct this defk::iency. By taking t!1is actirm, Fields Senior Lvki:g: at Spokrn1.e V~1He~l ~s or wui hi· in ~:m;JPl~an•:.-9 vvlth this !::.rtv and/ nrn~_;;i:u~atkin on r, (Date) ;)_.;), UJ 2 5 . !t l: Btk.:Ht1cn, I \~~H h11p~ernent a svstern to rnonitor and enstHB tm1t~nu~d cornph_;;,111te ~·~lHh Athis: req: .ir€tnent. .[;}l;J66 < Jz~ -Iv 3. z ;l_(} Administrator {er Repre'S-ent11hv1::) Date Statement of Deficiencies License #: 2669 Compliance Determination # 55570 Plan of Correction Fields Senior Living at Spokane Valley Completion Date Page 5 of 5 Licensee: Spokane Valley Seniors Housing, LLC 03/04/2025 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, Fields Senior Living at Spokane Valley 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 This document was prepared by Residential Care Services for the Locator website.