Rose Pointe Assisted Living.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Ii □ □ . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALT H SERVICES HOME AND COMMUNITY LIVING ADMINISTRATION 8517 E Trent Ave~ Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2452 .Compliance Determination # 72136 Plan of Correction Rose Pointe Assisted Living 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 colle.ction for an unannounced on-site complaint investigation on 01/29/2026 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following complaint number(s): 209792, 209212, 209540, 209327 The following sample was selected for review during the unannounced on-site visit: 6 of 86 current residents and 0 fonner residents. The department staff that investigated the Assisted Living Facility: Sandra Fast, Community Complaint Investigator From: DSHS, Home and Community Living Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 . VVMVU VI """"'1111;:JV\II' Statement of Deficiencies License#: 2452 Compliance Determination # 72136 Plan of Correction Rose Pointe Assisted Living Completion Date Page 2 of3 Licensee: RP Operations, LLC 02(18/2026 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. 02/24/2026 Residential Car~' ervices 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. c!2 / ;;. '-1/ rQool (1) Date WAC 388-78A-2210 Medication services. {1) An assisted living facility providing medication service, either directly or indirectly, must: (b) Develop and implement systems that support and promote safe medication service for each resident. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure safe medication services for 1 out of 6 residents {Resident 1) . This failure resulted in Resident 1 ingesting medications that may have been contaminated and placed the resident at risk of health complications. Findings included ... Review of the facility's policy titled, "Medication Services," with an effective date of July 2018, showed that any spilled, contaminated or dropped medication would be destroyed and a new dose of uncontaminated medication would be obtained. Review of Resident 1's Negotiated Service Agreement (NSA), dated 10/29, showed that the resident needed staff's assistance with self-administratjon of all their medications. Review of Resident 1 's progress note, dated 01/19/2026 at 7:03 PM showed, showed a few of the resident's medications were dropped on the floor. Further review of the resident's progress note showed that the resident was allowed to take the contaminated medications that had been on the floor. . .. , Statement of Deficiencies License #: 2452 Compliance Determination # 72136 Plan of Correction Rose Pointe Assisted Living Completion Date In an interview on 02/18/2026 at 11:31 AM. Staff A, Executive Director, stated that Resident 1 had taken medications after they had be.en dropped on the floor. Staff A further stated that the resident decided to take the contaminated medication. In an interview on 01/22/2026 at 1 :43 PM, Resident 1 stated that Staff B, Medication Technician, brought them their medications and that the medications were dropped on the floor. The resident stated that the medication technician, "scooped up," the dropped medications and told the resident to take them. The resident stated that they took the contaminated medications. This is a recurring deficiency previously cited on 12/10/2025. PlanfAttestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking-thi.s action, Rose Pointe Assisteld Living_ is Y or will be in compliance with this law and I or regulation on (Date) <? I O3 _9&. CP. In addition, I will .implement a system to monitor and ensure conti.nued compliance with this re uirement. • Date

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 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2452 Compliance Determination # 69505 Plan of Correction Rose Pointe Assisted Living Completion Date You are required to be in compliance at all times with all licensing laws and regulations to maintain your Assisted Living Facility license. The department completed data collection for the unannounced on-site full inspection and complaint investigation on 12/01/2025, 12/02/2025, 12/03/2025, 12/04/2025 and 12/09/2025 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following complaint numbers: 202375, 201020, 204271. The following sample was selected for review during the unannounced on-site visit: 18 of 89 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Brian Zbylski, ALF Licensor Carla Rose, NCI Community Licensor Joy Pipgras, LTC Surveyor From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 . Statement of Deficiencies License #: 2452 Compliance Determination # 69505 Plan of Correction Rose Pointe Assisted Living Completion Date As a result of the on-site visit(s) the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. Administrator (or Representative) Date 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 his or her individuality. WAC 388-78A-2660 Resident rights. The assisted living facility must: (1) Comply with chapter 70.129 RCW, Long-term care resident rights; This requirement was not met as evidenced by: Based on observation and interview, the facility failed to ensure that care was provided with dignity for 7 of 18 sampled residents (Resident 7, 9, 14, 15, 16, 17 and 18) and failed to ensure that food was not served on disposable dinnerware in 2 of 2 living areas (Memory Care and Assisted Living). This failure resulted in Resident 14 feeling insulted to have to use disposable dinnerware and Resident 9 not being able to use their own bathroom. Findings included… <Dignity> Observation on 12/01/2025 at 9:20 AM showed 10 residents in the memory care (living area designated for residents with significant cognitive deficits that had an increased need for assistance) activity room with no staff present. Resident 15 was observed sitting three feet away from the television and sleeping. Observation showed that Resident 18 sat directly behind Resident 15, and their knees were touching the back of Resident 15’s reclining wheelchair, with no view of the television. . Statement of Deficiencies License #: 2452 Compliance Determination # 69505 Plan of Correction Rose Pointe Assisted Living Completion Date Observation on 12/01/2025 at 12:08 PM, during the memory care unit’s lunch service, showed that Resident 15 had scrambled eggs on their clothing. Review of the facility menu showed eggs were served for breakfast on 12/01/2025. Observation on 12/03/2025 at 11:50 PM, showed Resident 7, Resident 15 and Resident 16 were served lunch. Resident 15 was observed to eat mashed potatoes and gravy using their fingers. Observation showed Residents 7 and Resident 16 did not start eating and were not assisted or cued by staff to eat. In an interview on 12/04/2025 at 12:40 PM, Resident 9 stated that they had put in multiple requests for a new roommate because their roommate urinated on the floor in the bathroom daily. Resident 9 further stated that they frequently had to use the bathroom in the lobby to avoid stepping into the urine. Observation on 12/04/2025 at 1:05 PM, showed a large puddle on the floor at the base of the toilet in Resident 9’s bathroom. The room had an odor of urine. <Dinnerware> Observation on 12/01/2025 at 11:45 AM, showed the memory care dining room was set up with disposable dinnerware. In an interview on 12/01/2025 at 11:47 AM, Staff N, Server, stated they did not have enough time to set up traditional dinnerware. In an interview on 12/02/2025 at 11:10 AM, Resident 17 stated that they had eaten off disposable plates and silverware for breakfast that morning in the assisted living dining room. In an interview on 12/02/2025 at 1:00 PM, Resident 14 stated that when they were served food on disposable dinnerware, it felt “insulting.” In an interview on 12/02/2025 at 4:00 PM, Staff F, Executive Director, stated that kitchen staff were aware they were not supposed to serve meals on disposable dinnerware, and that they should have been serving on glassware. In an interview on 12/03/2025 at 12:05 PM, Staff L, Cook, stated that the facility used disposable dinnerware when they were short staffed. . Statement of Deficiencies License #: 2452 Compliance Determination # 69505 Plan of Correction Rose Pointe Assisted Living Completion Date This is a recurring deficiency previously cited on 12/27/2024 for WAC 388-78A-2660, on 06/18/2024, and on 10/26/2023. 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, Rose Pointe Assisted Living 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-3090 Maintenance and housekeeping. (1) The assisted living facility must: (a) Provide a safe, sanitary and well-maintained environment for residents; (b) Keep exterior grounds, assisted living facility structure, and component parts safe, sanitary and in good repair; (c) Keep facilities, equipment and furnishings clean and in good repair; and This requirement was not met as evidenced by: Based on observation and interview, the facility failed to ensure the environment was well maintained, safe and sanitary in 2 of 2 facility areas (Interior and Exterior). This failure placed residents at risk of injury and a decreased quality of life. Findings included… Observations on 12/01/2025 at 9:20 AM and 12/03/2025 at 11:32 AM, showed the following: <Interior> -Air vents full of debris throughout the facility. . Statement of Deficiencies License #: 2452 Compliance Determination # 69505 Plan of Correction Rose Pointe Assisted Living Completion Date -Strong odor of urine in the Memory Care Unit (MCU) bathroom, adjacent to the activity room. -Maintenance staff stated in an interview during the environmental tour that the MCU bathroom shower was not in working order. Observation showed the shower had a torn sheet as a shower curtain. -MCU activity room contained three chairs that had faux leather covers with numerous rips, cracks, and peeling surfaces and a broken plastic laundry basket with jagged points and sharp edges. -MCU freezer had spilled food and debris. -MCU dining room steam tables were covered in food and debris, prior to lunch service and following the breakfast service. -MCU dining room door frame had rough surfaces that could not be cleaned, and shredded wood that could cause potential harm. -Assisted living carpets in all halls had numerous black spills and stains. -Assisted living doorways into resident rooms had numerus corners that were damaged and baseboards that were unattached. -Multiple doors and kick plates were damaged with residual adhesive on them. -Room 40's shower/tub did not drain properly, leaving standing water in the base, the bathroom flooring was buckled with black stains that appeared to be seeping through the underside, and a stained toilet bowl. -Room 9 had leaking water around the toilet with a black substance surrounding the base of the toilet. -Room 29's heater was not producing heat, and the resident was observed wearing a coat in bed. <Exterior> . Statement of Deficiencies License #: 2452 Compliance Determination # 69505 Plan of Correction Rose Pointe Assisted Living Completion Date -The far northwest door onto the assisted living courtyard was broken and swung into the exterior siding leaving an eight inch by 10-inch hole. -Cigarette butts littered the ground behind and surrounding the covered smoking area.

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 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2452 Compliance Determination # 63438 Plan of Correction Rose Pointe Assisted Living 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 08/14/2025 and 07/31/2025 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following complaint number(s): 187373 The following sample was selected for review during the unannounced on-site visit: 14 of 87 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Abigail Vanderkolk, Community Complaint Investigator Amy Wright, NCI Complain Investigator From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 . 08.27.2025 14:05:52 state of l-lashington 5/10 Stat~ment •;:)'f Gef1d'::ndes Ucense #: 24S2 Complian~.e De~e.m1inafo:m # 8-3438 Pian oi Corrndion R~ss Poime Assisted U\lii:"lg Cmnpistk,11 0;:ite As a result of tt,e on-site visit(sL the riepartment fr)und that you ~re nnt in .::umpl\tmce v,:itri the !itensin9 hl\.,,.iS ~nd r~gHlab,1f!s. ~t.,- sttlteii in the c.it:~ci d~tk:1et1d1s in the e-nd-n,-s~d r~port. 08/27/2025 l :1ndersta,nd that to rT'iarntain an .Assisted Ul/ing Facility h:ense, tt1e fadlity must be ln cr)t-r,p\;ance ~...,•\th all the hcens.ing !a\<vs ancl regtilations at ;a;; bme5. "'/1 -------...J Administrator (or Repr-esei:tative} WAC 388•78:A-3~ Maintenance and housekeeping, ( ·i) The assisted living hE-fty rnust (d) Ens.urn sach resident er staff parson rn.aintahs the rBsided'5 quaiters in a -sat.:: ~r,d sanitary condition Ct)rtS:stent wlth the neg-0ti:att;d :seNir::e agreement Thb requirement was not met as eviden,;ed by·: Bt.lsed i'.:i•n oln;arvatki·n, intervie~·v, ami re;:;ord rev!e~v, the facdit}' failed to ensure that the resi,d~nts' quarters .,,,verB maintalned 1~1 a sa~e 2nd sanitary condition i:cmsisten:t wlth the resident's nBgotiated rn, servk:e-a1;reementfor ·i1 :::if 14residentqRe5\rlents i, 2, 3.4., S, 6, 7. 8, 9, and 1-n.Thisfall€d pr~dice re suited in unhygienic. hving quattern v\tlk::h pl:a::ed l1fte.c.ted residents at risk tor d€creased quality af life :and e:,::po:s.ure to contaminants: and allergens. Revitw of an undated d1-sdasure i::,f services, sh(l;~'"'f:!d that th:e fadl~ty \·'Vas ta mamtJin the res;dents· lhdng qtrn:rters and other areas they rn~y use in a s-afo, c!~an tind .:::on·,fortable condition. In an ir\tervlew 0n 07i2B/2H2S at I: 32 PM, Staff A. M ~Iritenar1<:.::e O!r:ector, :stated th~t th~ fcidHty had bt:;tn ct~allng :1o'\•Rh an fnfestatir;m Gf •::oci,;rnacnes fc1r the la'5Ji. three and~ haM n1.-..mths. !;>'tatf .A. state(i that a pest <::'.'lntro! ,:ompanv cBrne in B::d placed trap;:;; near th,;; r<1;-frigernt~rs in the residents· rooms when:. the roaches. had been 5p,:;tted. Staff A stated ther:e V'ieff:. no health ,:::::in-eErns. \·•,;'ith codi;n:ii:.iches, thl'..mgr: they W.€re a m1~s.ainci:· and har-ct to get rld of. Staff A stated th::.~t some re:s\dents brought up i:cncerns ~bout the co'i:kroa..::hes n, In an interv,w€ · -t.m 08i07l2:D25 at n: 58 i--\M ,_C o!l<'lter-al Cont-a,::-t 1 {CC Account M tirulg,e,n\~tr~ the fadiity's pest contn:,I cGmpany, stattd that on G@/03/2025 ,i)r . Statement of Deficiencies License #: 2452 Compliance Determination # 63438 Plan of Correction Rose Pointe Assisted Living Completion Date As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. Administrator (or Representative) Date WAC 388-78A-3090 Maintenance and housekeeping. (1) The assisted living facility must: (d) Ensure each resident or staff person maintains the resident's quarters in a safe and sanitary condition consistent with the negotiated service agreement. This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to ensure that the residents’ quarters were maintained in a safe and sanitary condition consistent with the resident’s negotiated service agreement for 11 of 14 residents (Residents 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11). This failed practice resulted in unhygienic living quarters which placed affected residents at risk for decreased quality of life and exposure to contaminants and allergens. Findings included… Review of an undated disclosure of services, showed that the facility was to maintain the residents’ living quarters and other areas they may use in a safe, clean and comfortable condition. In an interview on 07/29/2025 at 1:32 PM, Staff A, Maintenance Director, stated that the facility had been dealing with an infestation of cockroaches for the last three and a half months. Staff A stated that a pest control company came in and placed traps near the refrigerators in the residents’ rooms where the roaches had been spotted. Staff A stated there were no health concerns with cockroaches, though they were a nuisance and hard to get rid of. Staff A stated that some residents brought up concerns about the cockroaches. In an interview on 08/07/2025 at 11:58 AM, Collateral Contact 1 (CC1), Account Manager with the facility’s pest control company, stated that on 06/03/2025 or . Statement of Deficiencies License #: 2452 Compliance Determination # 63438 Plan of Correction Rose Pointe Assisted Living Completion Date 06/04/2025, they went to the facility for an inspection and they saw that Rooms 1-15 showed signs of cockroach infestation. CC1 stated they gave the facility glue traps for monitoring. CC1 stated that a couple of days later they sent a quote for cockroach extermination to the facility. CC1 stated that on 08/18/2025, they noticed the quote was never looked at. CC1 stated they then called the facility three or four times but received no response from the facility. CC1 stated that the facility is contracted for general pest control, but they do not have a contract with the facility for cockroach management. CC1 stated that the glue boards were used for monitoring and not for treatment, and that nobody from the pest control company had gone out to the facility for extermination services. CC1 stated that cockroaches carried several allergens, they were extremely unhygienic, and they crawled over food sources that humans left out. CC1 stated that this side of the state had German cockroaches, which spread twice as fast as other roaches, and they left fecal matter. In an interview on 08/07/2025 at 12:25 PM, Staff A stated that a quote was sent to Staff B, Executive Director, but Staff A was not sure what happened after that. In an interview on 08/14/2025 at 11:28 AM, Staff B stated that it was back in March 2025, the pest control company initially came out regarding the cockroaches. Staff A stated they did not recall seeing the quote for cockroach extermination the first time it was sent a few months ago. <Room > Review of an undated facility characteristic roster, showed that Resident 10 and Resident 11 lived in Room . Review of a negotiated service agreement (NSA) for Resident 11, dated 12/23/24, showed that the resident’s housekeeping and home management needs were to be met by the facility. Review of an NSA for Resident 10, dated 02/27/2025, showed that the resident’s housekeeping and home management needs were to be met by the facility. An observation on 07/29/2025 at 2:30 PM, showed a cockroach in a trap in Room . <Room > Review of an undated facility characteristic roster, showed that Resident 3 and Resident 4 lived in Room . Review on an NSA for Resident 4, dated 07/30/2024, showed that the resident’s housekeeping and home management needs were to be met by the facility. Review of an NSA for Resident 3, dated 02/10/2025, showed that the resident’s housekeeping and home management needs were to be met by the facility. An observation on 07/29/2025 at 2:00 PM, showed an adult cockroach in a trap behind the refrigerator in Room . An observation on 08/14/2025 at 12:26 PM, showed that the carpet between the . Statement of Deficiencies License #: 2452 Compliance Determination # 63438 Plan of Correction Rose Pointe Assisted Living Completion Date residents’ rooms in Room was nearly entirely covered with brown stains of varying sizes.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration PO Box 45600, Olympia, WA 98504-5600 December 24, 2025 ELECTRONIC-FACSIMILE Administrator Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 Assisted Living Facility License # 2452 Licensee: RP Operations, LLC IMPOSITION OF CIVIL FINES Dear Administrator: On December 10, 2025, the Department of Social and Health Services (DSHS), Residential Care Services completed a Full Inspections and Complaint Investigation at your facility. This letter constitutes formal notice of civil fines on the license for your assisted living facility, also known as Rose Pointe Assisted Living, located at 13013 E Mission Ave, Spokane Valley, by the State of Washington, Department of Social and Health Services. These actions are taken under the authority granted pursuant to Laws of 1998, Chapter 272 and RCW 18.20.190. The civil fines on the license are based on the following violation of the RCW and/or WAC as described in the attached Statement of Deficiencies (SOD) report dated December 10, 2025. Civil Fines RCW 70.129.140 (1) Quality of life -- Rights. WAC 388-78A-2660 (1) Resident rights. $500.00 The licensee failed to ensure that care was provided with dignity for seven residents and and failed to ensure that food was not served on disposable dinnerware in two living areas. This failure resulted in one resident feeling insulted to have to use disposable dinnerware and another resident not being able to use their own bathroom. This is a recurring deficiency previously cited on December 27, 2024, for WAC 388-78A- 2660, on June 18, 2024, and on October 26, 2023. Administrator Rose Pointe Assisted Living License # 2452 December 24, 2025 Page 2 NOTE: These are the violations, which resulted in the fines; see the attached Statement of Deficiencies for any additional violations. WAC 388-78A-3090 (1)(a)(b)(c) Maintenance and housekeeping. $300.00 The licensee failed to ensure the environment was well maintained, safe and sanitary in two facility areas. This failure placed residents at risk of injury and a decreased quality of life. This is a recurring deficiency previously cited on June 17, 2025, for subsections (1) (a) (c), December 27, 2024, for subsections (1) (a) (b), and June 18, 2024. Attestation (Plan of Correction): Return the enclosed SOD within 10 calendar days with the following: • The date you have or will have each deficiency corrected; • A signature and date attesting that you are taking actions to correct and maintain correction for each cited deficiency. Return the signed and dated SOD to: Stephanie Jenks, Field Manager Region 1, Unit B 8517 E Trent Ave, Suite 102 Spokane Valley, WA 99212-2329 Phone: (509) 993-7821/ Fax: 509-921-2426 rcsregion1email@dshs.wa.gov Appeal Rights: You have two appeal rights: Informal Dispute Resolution (IDR) and an Administrative Hearing. Each has a different request timeline. Informal Dispute Resolution [RCW 18.20.195] You have an opportunity to challenge the deficiencies and/or enforcement actions through the state's IDR process. All IDR requests must be in writing and include: • The deficiencies you are disputing; and • The method of review you prefer (face-to-face, telephone conference or documentation review). The written request must be received by the 10th working day from receipt of this letter. Administrator Rose Pointe Assisted Living License # 2452 December 24, 2025 Page 3 During the IDR process, you will have the opportunity to present written and/or oral evidence to dispute the deficiencies. You can make an IDR request and find directions on the IDR web page at: http://www.dshs.wa.gov/altsa/idr. Formal Administrative Hearing You may contest the civil fines by requesting a formal administrative hearing to challenge the deficiency, which resulted in the civil fines. All hearing requests must be in writing and include: • A copy of this letter; and • A copy of the Statement of Deficiencies. The written request must be received within twenty-eight (28) calendar days of receipt of this letter. Send your written request to: Office of Administrative Hearings PO Box 42489 Olympia, Washington 98504-2489 Payment: If you do not request a formal administrative hearing, the civil fines are due to the Office of Financial Recovery twenty-eight (28) calendar days after receipt of this letter. Mail a check for $800.00 payable to the ‘Department of Social and Health Services’, and if you have or have had a Medicaid resident(s), please include your ProviderOne ID Number # on the check, to: DSHS Office of Financial Recovery PO Box 9501 Olympia, WA 98507-9501 (360) 664-5919 / FAX: (360) 664-8401 OFRMMISVendor@dshs.wa.gov If the Office of Financial Recovery has not received your payment within twenty-eight (28) days after receipt of this letter, interest will begin to accrue immediately on the balance, at the rate of one percent per month. If you do not submit a hearing request or make payment within twenty-eight (28) days, the balance due will be recovered. Administrator Rose Pointe Assisted Living License # 2452 December 24, 2025 Page 4 NOTICE: State and federal law provide protections to defendants who are in military service, and to their dependents. Dependents of a service member are the service member’s spouse, the service member’s minor child, or and individual for whom the service member provided more than one-half of the individual’s support for one hundred eight days immediately preceding an application for relief. One protection provided is the protection against the entry of a default judgment in certain circumstances. This notice pertains only to a defendant who is a dependent of a member of the National Guard or a military reserve component under a call to active service, or a National Guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days. Other defendants in military service also have protections against default judgments not covered by this notice. If you are the dependent of a member of the national guard or a military reserve component under a call to active service, or a national guard member under a call to service authorized by the governor of the state of Washington, for a period of more than thirty consecutive days, you should notify the Department in writing of your status as such within twenty days of the receipt of this notice. If you fail to do so, then a court or an administrative tribunal may presume that you are not a dependent of an active duty member of the national guard or reserves, or a national guard member under a call to service authorized by the governor of the state of Washington, and proceed with the entry of an order of default and/or a default judgment without further proof of your status. Your response to the Department about your status does not constitute an appearance for jurisdictional purposes in any pending litigation nor a waiver of your rights. If you have any questions, please contact Stephanie Jenks, Field Manager, at (509) 993-7821. Sincerely, Matt Hauser Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 1, Unit B RCS Regional Administrator, Region 1 HCS Regional Administrator, Region 1 DDA Regional Administrator, Region 1 WA LTC Ombuds Office of Financial Recovery, Vendor Program Unit HQ Central Files DRW SN

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 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2452 Compliance Determination # 60490 Plan of Correction Rose Pointe Assisted Living 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 06/10/2025 and 06/03/2025 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following complaint number(s): 181511, 181444, 181338 The following sample was selected for review during the unannounced on-site visit: 4 of 89 current residents and 1 former residents. The department staff that investigated the Assisted Living Facility: Amy Wright, NCI Complain Investigator From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 . Statement of Deficiencies License #: 2452 Compliance Determination # 60490 Plan of Correction Rose Pointe Assisted Living Completion Date As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. Administrator (or Representative) Date WAC 388-78A-2920 Area for nursing supplies and equipment. (1) In each building, the assisted living facility must provide for the safe and sanitary storage and handling of nursing equipment and supplies appropriate to the needs of their residents, as well as for the soiled nursing equipment by providing: (a) A "clean" utility area for the purposes of storing and preparing nursing supplies, or durable and disposable medical equipment equipped with: (i) A work counter or table; and This requirement was not met as evidenced by: Based on observation and interview, the facility failed to provide sufficient sanitary storage space for nursing supplies and equipment, with work surfaces for preparation of supplies, in 3 of 5 facility locations (Room , the bathroom on the south end of the memory care dining room, and the staff bathroom in the nurses’ office on Hall 1). This failed practice placed residents at increased risk for illness and health complications related to exposure to unsanitary resident care supplies and equipment. Findings included… In an interview on 06/03/2025 at 9:37 AM, Collateral Contact 1 stated that when they used the staff bathroom, they saw sterile items stacked in the shower next to the toilet. In an interview on 06/03/2025 at 11:48 AM, Staff A, Executive Director, stated that the facility did store medical supplies in the bathroom. Staff A stated they had to because of a lack of storage space. . Statement of Deficiencies License #: 2452 Compliance Determination # 60490 Plan of Correction Rose Pointe Assisted Living Completion Date Observation on 06/03/2025 at 12:18 PM showed that mattresses, walkers, and wheelchairs were being stored in Room . The sheetrock had been removed from the walls and the surfaces of the room itself were uncleanable. Observation on 06/03/2025 at 1:23 PM showed that nursing supplies including wipes, gloves, and briefs were being stored in the bathroom on the south side of the memory care dining room. There was no table or counter observed in the bathroom. Observation on 06/03/2025 at 1:33 PM showed that the shower next to the toilet in the staff bathroom (inside the nurses’ office on hall 1) contained adult washcloths and plastic carts full of personal protective equipment and urine specimen cups. There was no table or counter observed in the bathroom. This is a recurring citation previously cited on 06/28/2024 for subsections (1)(a). 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, Rose Pointe Assisted Living 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-3090 Maintenance and housekeeping. (1) The assisted living facility must: (a) Provide a safe, sanitary and well-maintained environment for residents; (c) Keep facilities, equipment and furnishings clean and in good repair; and This requirement was not met as evidenced by: Based on observation and interview, the facility failed to ensure that general maintenance was completed, water stains were addressed, and carpets were clean for 2 of 3 facility halls, (Hall 1 and Hall 2), and carpets were clean for 1 of 5 sampled residents (Resident 2). The facility failed to ensure that light fixtures were maintained for 1 of 2 facility halls (Hall 2). The facility failed to ensure that general maintenance . Statement of Deficiencies License #: 2452 Compliance Determination # 60490 Plan of Correction Rose Pointe Assisted Living Completion Date and cleaning tasks were completed for 2 of 2 resident common areas (the dining room and the television room) and 2 of 5 sampled resident rooms (Resident 1 and Resident 2). This failed practice resulted in resident dissatisfaction and placed residents at risk for injury, harm due to unsanitary living conditions, and a decreased quality of life. Findings included… Observation on 06/03/2025 at 12:21 PM showed an electrical outlet with no cover on the east wall of the television room. Observation on 06/03/2025 at 12:23 PM showed water damage to the ceiling in front of Room . The stain was one foot in diameter. Observation on 06/03/2025 at 12:25 PM showed a cracked and separated door jam on an unmarked room on the east side of Hall 1. Observation on 06/03/2025 at 12:27 PM showed the carpet in Room ’s hallway appeared dirty with multiple brownish stains of varying sizes. Observation on 06/03/2025 at 12:28 PM showed there was a dark brown substance surrounding the base of the toilet in Room . Observation on 06/03/2025 at 12:29 PM showed that the slats of a ceiling vent in Room were covered in dust. A portion of the wall had paint scraped off of it. The linoleum floor appeared dirty. The door jam had many dings and dents where the paint and wood were chipped off. Observation on 06/03/2025 at 12:29 PM showed an area of water damage on the ceiling above an unmarked door on the west side of Hall 1. The area of water damage was greater than a foot in diameter. Observation on 06/03/2025 at 12:31 PM showed two brown stains on the carpet in the Hall 1. The stains were one half to one foot in diameter. The stains were surrounded by multiple other stains of varying sizes. Observation on 06/03/2025 at 12:36 PM showed that the carpet outside Room was almost entirely covered with brown stains of varying sizes. Observation on 06/03/2025 at 12:39 PM showed that the chair rail along the north side of the dining room had chipped and peeling paint. Peeling wallpaper was also observed. . Statement of Deficiencies License #: 2452 Compliance Determination # 60490 Plan of Correction Rose Pointe Assisted Living Completion Date Observation on 06/03/2025 at 12:41 PM showed a thick layer of dust on the cabinet shelves on the east side of the dining room. Observation on 06/03/2025 at 12:42 PM showed that the light fixture on the ceiling outside of the laundry room adjacent to the dining room had one out of four light bulbs missing. Only one of the three remaining light bulbs worked. There was no cover over the light bulbs. Observation on 06/03/2025 at 12:43 PM showed that the light fixture on the ceiling outside the memory care door had three out of four light bulbs missing. There was no cover over the light bulbs. The area was dimly lit. Observation on 06/03/2025 at 12:43 PM showed there was insulation exposed where the washer lines entered the wall in the laundry room on Hall 2. Observation on 06/03/2025 at 12:46 PM showed that the carpet in the hallway on Hall 2 had multiple brown stains of varying sizes.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: Rose Pointe Assisted Living Provider Type: Assisted Living Facility License/Cert.#: 2452 Intake ID: 167717 Compliance Determination #: 55591 Region/Unit #: RCS Region 1 / Unit B Investigator: Amy Wright Investigation Date(s): 02/28/2025 through 03/05/2025 Complainant Contact Date(s): 02/28/2025, 03/10/2025 Allegation(s): Resident with memory deficits sent to appointment alone with inadequate clothing. Investigation Methods: Sample: Total residents: 93 Resident sample size: 5 Closed records sample size: 0 Observations: Alleged Victim Residents Dining Resident care equipment Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Executive Director Reporter Alleged Victim Alleged Victim's Representative Residents Record Reviews: *Disclosure of Services *Characteristic roster *Staff roster *Resident face sheets *Resident care plans *Progress notes *Facility fee scale *Resident billing statements *Weekly menus *Menu Change Policy *Resident care assessment Investigation Summary: . Review of the Alleged Victim's care plan showed that it failed to identify whether or not the resident was able to safely leave the facility unsupervised. The Alleged Victim's Representative was interviewed, and they stated that the resident needed supervision when leaving the facility due to memory deficits. Review of the department's reporting database showed no facility reports for the abandonment of the Alleged Victim. Failed practice identified and cited under WAC 388-78A-2140 Negotiated service agreement contents (7) and WAC 388-78A-2630 Reporting abuse and neglect (1)(a). 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 8517 E Trent Ave, Ste 102, Spokane Valley, WA 99212 Statement of Deficiencies License #: 2452 Compliance Determination # 55591 Plan of Correction Rose Pointe Assisted Living 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 02/28/2025 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following complaint number(s): 165886, 167556, 167717 The following sample was selected for review during the unannounced on-site visit: 5 of 93 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Amy Wright, NCI Complain Investigator From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 . Statement of Deficiencies License #: 2452 Compliance Determination # 55591 Plan of Correction Rose Pointe Assisted Living Completion Date As a result of the on-site visit(s), the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. Administrator (or Representative) Date WAC 388-78A-2300 Food and nutrition services. (1) The assisted living facility must: (c) Ensure all menus: (ii) Indicate the date, day of week, month and year; (iv) Are kept at least six months; (v) Provide a variety of foods; and (f) Substitute foods of equal nutrient value, when changes in the current day's menu are necessary, and record changes on the original menu; (g) Make available and give residents alternate choices in entrees for midday and evening meals that are of comparable quality and nutritional value. The assisted living facility is not required to post alternate choices in entrees on the menu one week in advance, but must record on the menus the alternate choices in entrees that are served; This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure that their weekly menus were dated appropriately, that the menus were maintained for six months, that residents were served a variety of foods, that menu substitutions had equal nutrient value, and that alternative choices were provided for 3 of 3 residents (Resident 2, Resident 3, and Resident 4). This failed practice placed residents at risk for inadequate nutrition and decreased quality of life. Findings included… . Statement of Deficiencies License #: 2452 Compliance Determination # 55591 Plan of Correction Rose Pointe Assisted Living Completion Date Review of the facility’s weekly menus, dated for January, showed there was no documentation to show which year the menus were for. Review of the weekly menus showed there was no menu for the week of January the 12th. Review of the weekly menus showed there was no record of the alternative choices that were served. Review of the weekly menus showed that on 01/26, the breakfast, lunch, and dinner menu options were scribbled out but there was no documentation to show what was served instead. Review of the weekly menus showed that on 01/27 and 01/28, there was no propane, so the residents were served cereal, applesauce, yogurt, fruit and granola for breakfast both days. The menu showed that pizza and a brownie was served for lunch on 01/27, and ham and a cookie was served for lunch on 01/28. Review of the facility’s weekly menus, dated for February, showed there was no documentation to show which year the menus were for. Review of the weekly menus showed there was no record of the alternative choices that were served. Review of the weekly menus showed that on 02/14, the kitchen was frozen so cereal was served for breakfast and pizza was served for lunch. Review of the weekly menus showed that on 2/17, cereal was served for breakfast and pizza was served for lunch. In an interview on 02/28/2025 at 8:01 AM, Staff B, Medication Technician, stated there was no back-up plan when the portable kitchen trailer went out. Staff B stated there was a two week period when the residents had cereal for every breakfast, pizza for every lunch, and sandwiches for every dinner. In an interview on 02/28/2025 at 9:06 AM, Staff A, Executive Director, reported that about two to three weeks prior, the facility went through a whole week of frozen pipes in the mobile kitchen so they served cold cereal and pizza as they had no heat or power in the mobile kitchen. Staff A stated they were sure the residents were sick of pizza and cereal. In an interview on 03/05/2025 at 10:09 AM, Resident 2 stated there were several times over the last two months in which a peanut butter and jelly sandwich and the salad bar were the only options for lunch. Resident 2 stated they were served a lot of pizza and cold cereal in the last two months. Resident 2 stated they did not feel they were getting adequate nutrition. In an email communication sent on 03/05/2025 at 10:58 AM, Staff A stated they did not have the facility menu for the week of January 12, 2025. In an interview on 03/05/2025 at 3:20 PM, Staff B stated that the facility’s menus were not updated with what was actually served for part of January of 2025 because the kitchen director walked off the job and quit. Staff B stated that residents complained to them daily about the food when they were being served cereal, pizza, and sandwiches daily in January. Staff B stated that the only time the facility offers an alternative besides peanut butter and jelly is when they are serving fish. Staff B stated that two memory care residents, Resident 3 and Resident 4, were put on “no meat” diets about a . Statement of Deficiencies License #: 2452 Compliance Determination # 55591 Plan of Correction Rose Pointe Assisted Living Completion Date week and a half ago. Staff B stated that meat is typically served with every lunch and with most dinners so the residents were just given peanut butter and jelly sandwiches instead. 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, Rose Pointe Assisted Living 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-2140 Negotiated service agreement contents.

conclusion of the investigation. Failed practice identified and 2 citations under the following: WAC 388-78A-3090 (1 )(a)(b), WAC 388-78A-3030 (2)(d) and 1 consultation under WAC 388-78A-2950 (6). Conclusion/ Action: ~ Failed Provider Practice Identified/ Citation(s) Written D Failed Provider Practice Not Identified / No Citation Written □ NIA . Investigation Summary Report Provider/Facility: Rose Pointe Assisted Living Provider Type: Assisted Living Facility License/Cert.#: 2452 Intake ID: 158656 Compliance Determination #: 52024 Region/Unit#: RCS Region 1 / Unit B Investigator: Carla Rose Investigation Date(s): 12/20/2024 through 12/27/2024 Complainant Contact Date(s): 12/19/2024 Allegation(s): Residents wrongfully given discharge notices Investigation Methods: Sample: Total residents: 85 Resident sample size: 7 Closed records sample size: 0 Observations: named residents sampled residents Interviews: named residents sampled residents staff administrator Record Reviews: eviction notices progress notes investigations behavior plans notices provided to residents Investigation Summary: 1. The facility gave discharge notices to identified residents without completing necessary steps to avoid discharge. The discharge notice did not contain the reason for transfer, the location to which the residents will be transferred or contact information for the ombuds. Did not make any attempts to prevent or avoid the discharge for either resident. The facility did not have any other documentation to support the discharge of the residents. Failed practice identified under 388- 78A-2660 (1 )(4 ); RCW 70.129.110 (3)(a)(b)(c)(d)(5)(a)(c)(d). Conclusion / Action: ~ Failed Provider Practice Identified/ Citation(s) Written D Failed Provider Practice Not Identified / No Citation Written . 0 N/A Received by RCS 1/21/2025 12/30/2024 . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 8517 E T.renlAve~ Ste 10.2., Spokane Valle•y, 'WA 99212 Statement of Def1c1enc1es License#. 2452 Compliance De1ermmat1on #52024 Plan of Conection Rose Pointe Assisted Uvmg Completion Date Page 1 of7 Licensee: RP Operations, LLC 12127'2024 You are required to be in compliance at all times with all' licensing laws and regulations to maintain your Assisted Living Faci.lity license. The department completed data coUection for an unannounced on-site complaint investigation on 12/20/2024 and 12/27/2024 of: Ro,se Pointe Assisted Living 130 '13 E Mission Ave Spokane Valley, WA 992113 This document references the fallowing complaint number{s): 158598, 158656 The following sample was selected for review during the unannounced on-site visit 7 of 85 current residents arid Of ormer residents. The department staff that investigated the Assisted Living Facility: Carla Rose, NCt Community Licensor From: DSHS, Aging and long-Term Support: Administratlon Res[dential Care Services, Region 1 , Unit 8 8517 E Trent Ave, Ste '102 Spokane Valrey, WA 99212 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 c1tecl deficiencies m the enclosed report. iia~re Setvtces Date I understand that to maintain an Ass[sted Living Fadlity license, the facility must be in compliance with all the ticensing laws and regulations at all ttmes. 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 #: 2452 Compliance Determination # 52024 Plan of Correction Rose Pointe Assisted Living 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 12/20/2024 and 12/27/2024 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following complaint number(s): 158598, 158656 The following sample was selected for review during the unannounced on-site visit: 7 of 85 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Carla Rose, NCI Community Licensor From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 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. . . 12.31.2025 08:32:32 State of Mashlngton 7/13 Stst~n1ei1t of Oeficii:nciiis Ucense #: 24-52 CompH~nce Oetetminatic,n # 52024 Plan of C ortgctiots R!ite Pointe Assisted Livfog Compfo,tion D~te Pag1:1 2 of 1 i 212712014 Admmistrator tor Representtitive} WAC 388•78A-3030 ToJtet rooms and bathrooms. (2) The assisted living facility rr~st prnvide ~ach t{.)i!et room and ' athroom with: (d} Plumbh)9 tixtures designed for easy use and deaning and kept ln good repair: and This requirement was not met as evidenced by: Based a:n observat,~m and inh::tvi:ew, th~ facility f'ailed to repair the cr>ld-wat!::ir faucet in th~ residents' bathrnom sin!\ for t of 2 Residents (Resident 3) sampled for having operational water faw:::ets. This tsi!ure prevented Resident 3 frnm having the atmty to access cold water to adjust the water temperature in their bathroom sink. Findings indude.d ... In an interview on 12/20/2024 ~t 11: 35· AM, Resident 3 stated th at the cold water in their bath roam sink di,d not work, and they only had hat wafer to wash th~lr hands. Resident 3 staterl that they made verb.al requ~sts ., evt1y week for months" for maintenance tr:i repair the faucet. but the repairs Vv"t1re natdcne. Obsetvatiun on ·t 2l20.f2024 at ·i 1: 35 AM, showed the faticet for the cold water in Resident 3"$ (Room } bathroom sink did not \•,mk. In an interview on 12/27/2024 e'lt ·t 0:00 AJVl, Staff 8; Maintenance Dire-ctor, stated that they ;-\•ere ~~are Gt the hrnl<en faucet !n ResJdent 3's bathroom but they had not scnedu/erl repairs prior to the investigauon by the department. Plan/A ttestatlon Statement I h~r:eoy certify that I have reviev,•ed this report and have taken or wm t:Jke active meas.ur~s bl correct this defi:Ci~ncy. By takin::t this adion, Rose Point~ .Assisted Living~ or wm be in i::omp~i~mce w~th this l~w and J ix regulation an {Date} / - .S · 1....' -:; In a:clditi'on. I v\illr implement a system ta monitor and 1;:ns:Jre continued compliance with this requirement. Statement of Deficiencies License #: 2452 Compliance Determination # 52024 Plan of Correction Rose Pointe Assisted Living Completion Date Administrator (or Representative) Date WAC 388-78A-3030 Toilet rooms and bathrooms. (2) The assisted living facility must provide each toilet room and bathroom with: (d) Plumbing fixtures designed for easy use and cleaning and kept in good repair; and This requirement was not met as evidenced by: Based on observation and interview, the facility failed to repair the cold-water faucet in the residents’ bathroom sink for 1 of 2 Residents (Resident 3) sampled for having operational water faucets. This failure prevented Resident 3 from having the ability to access cold water to adjust the water temperature in their bathroom sink. Findings included… In an interview on 12/20/2024 at 11:35 AM, Resident 3 stated that the cold water in their bathroom sink did not work, and they only had hot water to wash their hands. Resident 3 stated that they made verbal requests “every week for months” for maintenance to repair the faucet, but the repairs were not done. Observation on 12/20/2024 at 11:35 AM, showed the faucet for the cold water in Resident 3’s (Room ) bathroom sink did not work. In an interview on 12/27/2024 at 10:00 AM, Staff B, Maintenance Director, stated that they were aware of the broken faucet in Resident 3’s bathroom but they had not scheduled repairs prior to the investigation by the department. 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, Rose Pointe Assisted Living 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. . . 12.31.2025 08:32:32 state of Mashington 8/13 Statement of Oeliciitndes licer,se #-. 2452 Compl:iarit~ Oetem1ihatfo1; # 52024 Plan of C ortectitWt: Rose P-0in1~ Ass:isted Living Ctmple-tion Date Page 3 of{ Uce!.se,!!: RP Operations, LLC ·i 2l27 l2024 Administ.rntor (or Representative) Date WAC-388..:Y8A..J09C Mafntenanc• and housekeepin;. {1 ) The assisted living fad!

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A .

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written . Failed Provider Practice Not Identified / No Citation Written N/A .

Statement of Deficiencies License #: 2452 Compliance Determination # 45082 Plan of Correction Rose Pointe Assisted Living 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 follow-up on 08/01/2024 and 08/01/2024 of: Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 This document references the following SOD dated: 08/01/2024 The following sample was selected for review during the unannounced on-site visit: 5 of 90 current residents and O former residents. The department staff that inspected the Assisted Living Facility: Joy Pipgras, LT C Surveyor Brian Zbylski, ALF Licensor From: DSHS, Aging and Long-Term Support Administration 8517 E Trent Ave, Ste 102 Spokane Valley, WA 99212 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. 08/08/2024 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. . 08.09.2024 13:50:21 !>'tate or wash in gton 4/1 Statement of Deficiencies License #: 2452 Compliance Determination # 45082 Plan of Correction Rose Pointe Assisted Living Completion Date ( Administrator (or Representative) WAC 388~78A-2730 Licensee's responsibilities. (1) The assisted living facility licensee is responsible for: (b) Complying at all times with the requirements of this chapter, chapter 18.20 RCW, and other applicable laws and rules; an(1 This requirement was not met as evidenced by: Based on interview and record review, the facility failed to ensure staff were fit tested with an N95 respirator (is a protective device designed to achieve a close facial fit and efficient filtration of airborne particles) for 5 of 5 sampled staff (Staff A, B, C, D and E). This failure placed residents at risk for exposure to respiratory infection. Findings Included ... Per Chapter 296-842 WAC, Respirators, the facility must implement a program/policy, conduct fit testing (test completed by specially trained personnel to ensure N95 respirator seal effectively reducing chance of exposure to respiratory viruses), and provide effective training before employees are assigned duties that may require the use of respirators. Per WAC 296-842-15005, facilities must conduct fit testing before employees are assigned duties that may require the use of respirators. Review of a Department of Social and Health Services provider tetter, dated 09/14/2023, showed that employers in long tenn care settings were responsible to "follow regulations pertaining to respiratory protection" including respirator fit testing for long term care workers. Revi.ew of the facility's respiratory protection program (RPP) showed that KN95 respirator (model 9502+) were used for staff fit testing. Review of Staff A's, Executive Director, undated personnel file showed it did not contain records for the required National Institute for Occupational Safety and Health (NIOSH) approved N95 respirator fit test. Review of Staff B's, Med Tech, undated personnel file showed it did not contain .records for the required NIOSH approved N95 respfrator fit test. . 08.09.2024 13:50:21 state of washington 5/6 Statement of Deficiencies License #: 2452 Compliance Determination # 45082 Plan of Correction Rose Pointe Assisted Living Completion Date Review of Staff C's, Caregiver, undated personnel file showed it did not contain records for the required NIOSH approved N95 respirator fit test. Review of Staff D's, Caregiver, undated personnel file showed it did not contain records for the required NIOSH approved N95 respirator fit test. Review of Staff E's, Med Tech, undated personnel file showed it did not contain records for the required NIOSH approved N95 respirator fit test. In an interview on 08/01/2024 at 4:07 PM, Staff A, Executive Director. stated that they had been fit testing their staff with KN95 respirator. In an observation at that time, Staff A provided the department with a sample respirator that did not show a NIOSH approval on the respirator or the packaging. This is an uncorrected deficiency previously cited on 06/18/2024. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take activex !1.g measures to correct this deficiency. By taking this action, Rose Point~ssi~d is or will be in compliance with this law and/ or regulation on (Date} ~ · 1· ( · L;::J... . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. u ·It. -i,,~ .............. 0 ...................................... Date . Investigation Summary Report Provider/Facility: Rose Pointe Assisted Living Provider Type: Assisted Living Facility License/Cert.#: 2452 Intake ID: 131901 Compliance Determination #: 42717 Region/Unit#: RCS Region 1 / Unit B Investigator: Patty Ford Investigation Date(s): 06/06/2024 through 06/18/2024 Complainant Contact Date(s): 06/25/2024 Allegation(s): 1. Resident was quarantined 2. Non-availability of medications 3. Lack of resident care 4. Care plans not updated 5. Staff credential 6. Food service Investigation Methods: Sample: Total residents: 90 Resident sample size: 18 Closed records sample size: 0 Observations: identified residents sample residents staff to resident interactions medpass Interviews: Identified residents sample residents Nursing staff Residents Record Reviews: Identified residents facility records Identified residents Medical records Identified residents Hospital records Sample residents facility records Personnel files facility policies Staff training records shower schedules Disclosure of services Characteristics Roster Investigation Summary: 1. Reporter stated that named resident was quarantined to their room when not . necessary. Resident went to the emergency room for shortness of breath, was positive for Covid 19 and went back to the facility and placed in isolation for 5 days. Hospital had called the facility to advise of positive COVID results. Review of records showed positive COVID test results from the hospital, resident interviewed and had no complaints about isolation policy. No failed practice identified. 2. Reporter stated that the resident went without necessary medications. Interviewed resident stated there were times when their medications were not available. Staff stated that medications were supposed to be ordered prior to running out. Record review of the medication administration records showed that resident had gone without their ordered medications. Failed practice identified and cited under Nonavailability of medications WAC 388-78A-2240. 3. Reporter stated that showers were not being provided per care plan agreement. Identified resident was interviewed and stated they preferred to take their showers by themselves. Identified resident appeared clean and groomed. Care staff were interviewed and confirmed that identified resident had taken showers on their own and repeatedly refused assistance for showers by staff. Residents interviewed did not report concerns regarding shower assistance and showers were given as scheduled. No failed practice identified. 4. Reporter stated that care plans were not updated and staff did not have access to them. Record reviews of sampled resident records showed all care plans were updated. Interviewed staff stated that care plans are available in the residents electronic and paper charts. No failed practice identified. 5. Reporter stated that unqualified staff were passing medications. Interviewed staff stated they had received training to pass medications. Review of sampled staff records showed that staff had received required training and credentials to pass medications. Interviewed residents did not report any concerns regarding the training of MedTech's. No failed practice identified. 6. Reporter stated that residents did not get milk when requested. Residents interviewed did not have complaints about snacks offered when they were hungry or requested. Staff stated that residents were given snacks when requested. Snacks and beverages were observed to be available for residents. No failed practice identified. Conclusion/ Action: ~ Failed Provider Practice Identified/ Citation(s) Written 0 Failed Provider Practice Not Identified / No Citation Written 0 N/A . 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 RP Operations, LLC Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 RE: Rose Pointe Assisted Living # 2452 Dear Administrator: This document references the following complaint numbers 133555, 132996, 132858, 132596, 131901, 131914, 130244. The Department completed a full inspection of your Assisted Living Facility on 06/18/2024 and found that your facility does not meet the Assisted Living Facility requirements.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Aging and Long-Term Support Administration PO Box 45600, Olympia, WA 98504-5600 August 9, 2024 ELECTRONIC-FACSIMILE Administrator Rose Pointe Assisted Living 13013 E Mission Ave Spokane Valley, WA 99216 Assisted Living Facility License # 2452 Licensee: RP Operations, LLC IMPOSITION OF CIVIL FINE Dear Administrator: On August 1, 2024, the Department of Social and Health Services (DSHS), Residential Care Services completed a follow-up visit at your facility. This letter constitutes formal notice of a civil fine on the license for your assisted living facility, also known as Rose Pointe Assisted Living, located at 13013 E Mission Ave, Spokane Valley, by the State of Washington, Department of Social and Health Services. These actions are taken under the authority granted pursuant to Laws of 1998, Chapter 272 and RCW 18.20.190. The civil fine on the license is based on the following violation of the RCW and/or WAC as described in the attached Statement of Deficiencies (SOD) report dated August 1, 2024. Civil Fine WAC 388-78A-2730(1)(b) Licensee's responsibilities. $400.00 The licensee failed to ensure staff were fit tested with an N95 respirator (a protective device designed to achieve a close facial fit and efficient filtration of airborne particles) for 5 staff. This failure placed residents at risk of exposure to respiratory infection. This is an uncorrected deficiency previously cited on June 18, 2024. NOTE: This is the violation, which resulted in the fine; see the attached Statement of Deficiencies for any additional violations. Administrator Rose Pointe Assisted Living License # 2452 August 9, 2024 Page 2 Attestation (Plan of Correction): Return the enclosed SOD within 10 calendar days with the following: • The date you have or will have each deficiency corrected; • A signature and date attesting that you are taking actions to correct and maintain correction for each cited deficiency. Return the signed and dated SOD to: Stephanie Jenks, Field Manager Region 1, Unit B 8517 E Trent Ave, Suite 102 Spokane Valley, WA 99212-2329 Phone: (509) 993-7821/ Fax: 509-921-2426 rcsregion1email@dshs.wa.gov Appeal Rights: You have two appeal rights: Informal Dispute Resolution (IDR) and an Administrative Hearing. Each has a different request timeline. Informal Dispute Resolution [RCW 18.20.195] You have an opportunity to challenge the deficiencies and/or enforcement actions through the state's IDR process. All IDR requests must be in writing and include: • The deficiencies you are disputing; and • The method of review you prefer (face-to-face, telephone conference or documentation review). The written request must be received by the 10th working day from receipt of this letter. During the IDR process, you will have the opportunity to present written and/or oral evidence to dispute the deficiencies. Send your written request to: Informal Dispute Resolution Program Manager Residential Care Services PO Box 45600 Olympia, Washington 98504-5600 Administrator Rose Pointe Assisted Living License # 2452 August 9, 2024 Page 3 Formal Administrative Hearing You may contest the civil fine by requesting a formal administrative hearing to challenge the deficiency, which resulted in the civil fine. All hearing requests must be in writing and include: • A copy of this letter; and • A copy of the Statement of Deficiencies. The written request must be received within twenty-eight (28) calendar days of receipt of this letter. Send your written request to: Office of Administrative Hearings PO Box 42489 Olympia, Washington 98504-2489 Payment: If you do not request a formal administrative hearing, the civil fine is due to the Office of Financial Recovery twenty-eight (28) calendar days after receipt of this letter. Mail a check for $400.00 payable to the ‘Department of Social and Health Services’, and if you have or have had a Medicaid resident(s), please include your ProviderOne ID Number # on the check, to: DSHS Office of Financial Recovery PO Box 9501 Olympia, WA 98507-9501 (360) 664-5919 / FAX: (360) 664-8401 OFRMMISVendor@dshs.wa.gov If the Office of Financial Recovery has not received your payment within twenty-eight (28) days after receipt of this letter, interest will begin to accrue immediately on the balance, at the rate of one percent per month. If you do not submit a hearing request or make payment within twenty-eight (28) days, the balance due will be recovered. Administrator Rose Pointe Assisted Living License # 2452 August 9, 2024 Page 4 If you have any questions, please contact Stephanie Jenks, Field Manager, at (509) 993-7821. Sincerely, Matt Hauser Compliance Specialist Residential Care Services Enclosure cc: Field Manager, Region 1, Unit B RCS Regional Administrator, Region 1 HCS Regional Administrator, Region 1 DDA Regional Administrator, Region 1 WA LTC Ombuds Office of Financial Recovery, Vendor Program Unit HQ Central Files DRW HP

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: Rose Pointe Assisted Living Provider Type: Assisted Living Facility License/Cert.#: 2452 Intake ID: 95553 Compliance Determination #: 29127 Region/Unit #: RCS Region 1 / Unit B Investigator: Amy Wright Investigation Date(s): 09/07/2023 through 10/26/2023 Complainant Contact Date(s): Allegation(s): 1. Multiple falls. 2. Resident refused readmission to facility. Investigation Methods: Sample: Total residents: 96 Resident sample size: 3 Closed records sample size: 0 Observations: Alleged Victim Residents Dining Resident care equipment Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Executive Director Wellness Director Alleged Victim's Family Residents Medication Technician Record Reviews: Disclosure of Services Characteristic roster Staff roster Resident face sheets Resident care plans Fall Protocol Policy Hospital after-visit summaries Resident incident reports Resident assessments Resident medication administration records Progress notes Provider notes Therapy notes Hospital discharge summary . Shower documentation Resident discharge notice Investigation Summary: 1. The named resident, who had a history of falls, was admitted to the facility without a preadmission assessment. A care plan to alert staff of their fall risk or of interventions to prevent falls had not been established. Review of facility documentation showed that the named resident's fall investigations lacked root cause analysis or implementation of measures to prevent reoccurrence. Failed facility practice was cited under WAC 388-78A-2060 Preadmission assessment, WAC 388-78A-2130 Service agreement planning, and WAC 388-78A-2371 Investigations. 2. Facility management felt they could not meet the needs of the named resident. The named resident's representative was notified of the facility's intent to discharge them. The facility decided to readmit the named resident until alternative placement could be found for them. The named resident was readmitted and was observed present in the facility. No failed facility practice. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: Rose Pointe Assisted Living Provider Type: Assisted Living Facility License/Cert.#: 2452 Intake ID: 95173 Compliance Determination #: 29127 Region/Unit #: RCS Region 1 / Unit B Investigator: Amy Wright Investigation Date(s): 09/07/2023 through 10/26/2023 Complainant Contact Date(s): Allegation(s): 1. Inadequate wound care. 2. Inadequate skin care. Investigation Methods: Sample: Total residents: 96 Resident sample size: 3 Closed records sample size: 0 Observations: Alleged Victim Residents Dining Resident care equipment Resident rooms Staff to resident interactions Resident to resident interactions Interviews: Executive Director Wellness Director Alleged Victim Resident Medication Technician Family Record Reviews: Disclosure of Services Characteristic roster Staff roster Resident face sheets Resident care plans Fall Protocol Policy Hospital after-visit summaries Resident incident reports Resident assessments Resident medication administration records Progress notes Provider notes Therapy notes . Hospital discharge summary Shower documentation Resident discharge notice Investigation Summary: 1. The facility noted the named resident's wound and notified their provider. The provider assessed the wound and provided treatment orders. Facility documentation showed that the treatment orders had been followed. The named resident was sent to the hospital for medical care the same day. Upon their return to the facility the provider assessed the named resident and their wound had resolved. The named resident was observed to have no open wounds. No failed facility practice. 2. The named resident had a medical condition that compromised their lower extremity skin integrity. Review of facility documentation showed there were no treatment orders in place to prevent lower extremity swelling or to improve the integrity of their skin. The named resident was observed to have dry, flaking skin on their lower extremities. Failed facility practice was cited under WAC 388-78A-2130 Service agreement planning. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . .