Fairwood Northridge Llc.

Statement of Deficiencies License #: 1989 Compliance Determination # 73463 Plan of Correction FAIRWOOD NORTHRIDGE LLC Completion Date Review of Resident 3’s December 2025 Medication Administration Record (MAR) showed the resident was prescribed alendronate (medication for bone strength) to be administered every Friday. Further review showed the medication was not administered on Friday 12/05/2025 and Friday 12/12/2025 with a note that documented they were “waiting on pharmacy.” In an interview on 2/24/2026 at 3:22 PM Staff M, Health Unit Coordinator, stated that Resident 3’s alendronate was in the medication cart and that staff should have administered it. Staff M stated that because it was packaged differently, the medication technician did not see it and assumed it had not been delivered from the pharmacy. Staff M stated that the medication technician should have notified them when they were unable to find the medication. <Resident 4> Review of Resident 4’s NSA, dated 12/02/2025, showed that the resident was diagnosed with . Further review showed that Resident 4 received medication assistance and that “staff will keep medications in med-cart, order, set up and dispense medications to resident as directed by physician.” Review of Resident 4’s December 2025, January 2026, and February 2026 MARs showed an order for lisinopril (medication for hypertension) to be administered daily. Further review showed that the medication was to be held if the resident’s heart rate was under 50 beats per minute. The MAR showed no documentation of the resident’s heart rate. In an interview on 02/24/2026 at 11:35 AM, Staff R, Registered Nurse, stated that Resident 4’s MAR should have had the heart rate listed on the MAR if a parameter was ordered. In an interview on 02/25/2026 at 12:44 PM, Staff R confirmed that staff had not obtained a heartrate for Resident 4 prior to administering the medication. In an interview on 02/25/2026 at 12:40 PM, Staff R stated that audits of the MARs for errors, medications not given, and refusals were conducted daily through review of an exceptions log generated by their electronic MAR system. Staff R further stated that they did not review the exceptions log, and that Staff O, Registered Nurse, was responsible for reviewing the exceptions logs. In an interview on 02/26/2026 at 2:45 PM, Staff O stated that they did not review the exceptions log due to time constraints. Staff O further stated that Staff R would inform them if any of their assigned residents had exceptions (medications not given, medication refusals, and medication errors). . Statement of Deficiencies License #: 1989 Compliance Determination # 73463 Plan of Correction FAIRWOOD NORTHRIDGE LLC Completion Date Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, FAIRWOOD NORTHRIDGE LLC 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-2230 Medication refusal. (1) When a resident who is receiving medication assistance or medication administration services from the assisted living facility chooses to not take his or her medications, the assisted living facility must: (c) Notify the physician of the refusal and follow any instructions provided, unless there is a staff person available who, acting within his or her scope of practice, is able to evaluate the significance of the resident not getting his or her medication, and such staff person; (ii) Takes the appropriate action, including notifying the prescriber or primary care practitioner when there is a consistent pattern of the resident choosing to not take his or her medications. This requirement was not met as evidenced by: Based on interview and record review, the facility failed to notify the prescribing health care provider of medication refusals for 1 of 11 sampled residents (Resident 9). This failure resulted in the provider being unaware that the resident was not receiving their medication as prescribed and placed the resident at risk of health complications. Findings included… Review of Resident 9’s face sheet showed that the resident was admitted to the facility on /2025. Review of Resident 9’s Client Assessment and Initial Plan of Care (the facility’s combined assessment and care plan), dated 12/08/2025, showed diagnoses of . Statement of Deficiencies License #: 1989 Compliance Determination # 73463 Plan of Correction FAIRWOOD NORTHRIDGE LLC Completion Date In an interview on 02/24/2026 at 4:10 PM, Staff L, Administrator, stated that during the week there was always a driver or staff available to go pick up medications from the local pharmacy if needed. <Resident 11> Review of Resident 11’s NSA, dated 09/30/2025, showed the resident was diagnosed with and . Further review showed the facility was responsible for the administration of the resident's medications. Review of Resident 11’s January 2026 and February 2026 MARs showed the resident was prescribed amlodipine (medication for high blood pressure) daily, ferrous sulfate (iron tablet) daily, multivitamin daily, and quetiapine (medication for sleep and mood) at bedtime. Further review of the MARs showed that the resident was not given amlodipine eight times in January 2026 and 11 times in February 2026, ferrous sulfate six times in February 2026, multivitamin six times in February 2026, and quetiapine three times in January 2026. In an interview on 02/26/2026 at 2:15 PM, Staff M was asked why Resident 11 had missed multiple doses of medications. Staff M stated that they were not notified that the residents’ medications had run out. 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, FAIRWOOD NORTHRIDGE LLC 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-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services to any resident, either directly or indirectly, the assisted living facility must: (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. . Statement of Deficiencies License #: 1989 Compliance Determination # 73463 Plan of Correction FAIRWOOD NORTHRIDGE LLC Completion Date (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: (d) Chapter 246-841 WAC, Nursing assistants; and This requirement was not met as evidenced by: Based on observation, interview, and record review, the facility failed to delegate nursing tasks when residents required medication administration and to complete nursing visit assessments every 90 days for 4 of 9 sampled residents (Resident 1, 5, 6, and 7). The facility failed to verify qualifications to perform nurse delegated tasks for 1 of 6 staff (Staff K) sampled for delegation. These failures resulted in the residents receiving delegated nursing tasks that may not have been performed safely or effectively, a lack of 90 day assessments to ensure continued appropriateness of nurse delegation, and Staff K completing delegated tasks without the necessary qualifications . Findings included… Review of Assisted Living Facility WAC 388-78A definitions, showed that medication assistance was determined by regulations under WAC 246-945. Review of WAC 246-945-718 showed medication assistance could only be provided if the individual was cognitively aware they received medications and took them independently or with assistance. If an individual was unable to receive medication by assistance, then medication must be administered by a person legally authorized to do so. Per WAC 246-840-010, delegation means the licensed nurse transfers the performance of selected nursing tasks to competent individuals in selected situations. The nurse delegating the task is responsible and accountable for the nursing care of the client. The nurse delegating the task supervises the performance of the unlicensed person. Nurses must follow the delegation process following the RCW 18.79.260. Per RCW 18.79 when the client is not functionally able and /or cognitively aware they are receiving medications, the long-term care workers is authorized to do so with delegation of the medication.

. . . . . . . . . . . Steps to prevent Reoccurrence State Survey 2024 (cid:120) WAC 388-78A-2474 (cid:120) WAC 388-112A-0611 Facility will ensure identified sta(cid:431) get caught up on their continue education and will monitor and ensure all sta(cid:431) complete their required continued education. (cid:120) WAC 388-78A-2320 1b & 3d 1) Initial Client Assessment 2) 90 day quarterlies 3) Delegation Training All new resident’s initial client assessment will include the list of caregivers assessed and delegated by our RN to ensure competency to perform delegated tasks in absence of supervisor. Nursing will complete supervisory visits every 90 days, and work with Administrator to maintain compliance. All sta(cid:431) required to have/show completion of appropriate nurse delegation training prior to performing any delegated tasks. This will be monitored by HR, Sarah Kring and Riley Knutson, Administrator to ensure compliance. (cid:120) WAC 388-78A-2090 Facility will complete 14 day assessment for all incoming residents. (cid:120) WAC 388-78A-2150 Facility will ensure that all care plans are signed by appropriate representatives (cid:120) WAC 388-78A-2160 Resident in question care plan adjusted to identify frequency of nail care to be completed by RN. RN, to document nail services appropriately to ensure care identified is being provided. All other DM residents audited and updated also. (cid:120) WAC 388-78A-2130 Facility will complete 30 day assessment for all incoming residents .

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