South Hill Village, Assisted Living & Memory Care.

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 #: 2478 Compliance Determination # 64069 Plan of Correction South Hill Village, Assisted Living & Memory Care Completion Date Page 1 of 6 Licensee: PSL Associates, LLC 08/13/2025 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 08/07/2025, 08/08/2025, 08/11/2025 and 08/12/2025 of: South Hill Village, Assisted Living & Memory Care 5925 S Hailee Lane Spokane, WA 99223 The following sample was selected for review during the unannounced on-site visit: 10 of 40 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Patricia Eddy, Community Licensor Brian Zbylski, ALF 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 #: 2478 Compliance Determination # 64069 Plan of Correction South Hill Village, Assisted Living & Memory Care Completion Date Page 2 of 6 Licensee: PSL Associates, LLC 08/13/2025 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-2950 Water supply. The assisted living facility must: (6) Provide all sinks in resident rooms, toilet rooms and bathrooms, and bathing fixtures used by residents with hot water between 105 F and 120 F at all times; and This requirement was not met as evidenced by: Based on observation, interview and record review, the facility failed to ensure that water temperatures were maintained between 105 and 120 degrees Fahrenheit in 2 of 2 common restrooms (Restroom 1 and 2), and 3 of 10 residents’ private bathrooms (Resident 1, 8 and 10) in the “A” House. This failure resulted in water temperatures being above and below the required limits and placed residents at risk of injury due to hot water temperatures. Findings included… Observation during the environmental tour with Staff G, Maintenance Director, on 08/07/2025 at 11:10 AM, showed the facility was divided into four sections, referred to as “A”, “B”, “C” and “D” houses. During the environmental tour, the water temperature in Restroom 1 was 101.8 F (degrees Fahrenheit) and Restroom 2 was 104.5 F in “A” house. Observation on 08/11/2025 at 9:32 AM, showed the water temperature in Resident 1’s bathroom sink was 101.6 F. In an interview at that time, Resident 1 stated that their water didn’t get very warm when they washed their hands. Observation on 08/11/2025 at 9:50 AM, showed the water temperature in Resident 10’s bathroom sink was 133.8 F. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2478 Compliance Determination # 64069 Plan of Correction South Hill Village, Assisted Living & Memory Care Completion Date Page 3 of 6 Licensee: PSL Associates, LLC 08/13/2025 Observation on 08/11/2025 at 9:56 AM, showed the water temperature in Resident 8’s bathroom sink was 134.0 F. In an interview on 08/11/2025 at 10:20 AM, Staff G stated that they knew that the measured temperatures were too high and they would adjust the temperatures down. Staff G further stated that they were not sure if water temperatures were being regularly monitored prior to their start of employment about one month prior. In an interview on 08/11/2025 at 2:55 PM, Staff G stated that the best practice for monitoring water temperatures was to check multiple sources and varying locations each time to ensure all areas of the building were monitored. Review of facility weekly water temperature logs from 01/30/2025 through 08/08/2025, showed that a single resident room in “B” house was checked one time during that period. There was no documentation to show any resident rooms in “A”, “C”, and “D” houses had water temperatures checked. 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, South Hill Village, Assisted Living & Memory Care 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 388-112A-0080 Who is required to complete the seventy-hour long-term care worker basic training and by when? The following individuals must complete the seventy-hour long- term care worker basic training unless exempt as described in WAC 388-112A-0090 : Adult family homes. (5) Long-term care workers in assisted living facilities within one hundred twenty days of their date of hire. Long-term care workers must not provide personal care without direct supervision until they have completed the seventy-hour long-term care worker basic training. Enhanced services facilities. WAC 388-112A-0105 Who is required to obtain home care aide certification and by when? Unless exempt under WAC 246-980-025 , the following individuals must be certified by the department of health as a home care aide within the required time frames: This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2478 Compliance Determination # 64069 Plan of Correction South Hill Village, Assisted Living & Memory Care Completion Date Page 4 of 6 Licensee: PSL Associates, LLC 08/13/2025 (1) All long-term care workers, within two hundred days of the date of hire; WAC 388-112A-0400 What is specialty training and who is required to take it? (4) All long-term care workers including those exempt from basic training who work in an assisted living facility, enhanced services facility, or adult family home who serve residents with the special needs described in subsection (3) of this section, must take a class approved as specialty training. The specialty training applies to the type of residents served by the home as follows: (b) Dementia specialty training as described in WAC 388-112A-0440 ; and (c) Mental health specialty training as described in WAC 388-112A-0450 . WAC 388-78A-2450 Staff. (3) The assisted living facility must: (d) Maintain the following documentation on the assisted living facility premises, during employment, and at least two years following termination of employment: (i) Staff orientation and training or certification pertinent to duties, including, but not limited to: (A) Training required by chapter 388-112A WAC; (B) Home care aide certification as required by this chapter and chapter 246-980 WAC; This requirement was not met as evidenced by: Based on observation, interview and record review, the facility failed to ensure training requirements were completed for specialty training for dementia and mental health for 3 of 5 staff (Staff A, B, and C), 70-hour basic training for long term care workers for 2 of 5 staff (Staff C and E), and home care aide certification for 1 of 5 staff (Staff E). This failure placed the residents at risk of receiving care from untrained staff. Findings included... <Specialty Training> Review of the facility’s undated Disclosure of Services showed they provided care and services for individuals with and diagnoses. Review of the Resident Characteristic roster, provided to the department on 08/07/2025 showed that all 40 current residents had a diagnosis of or . Staff A This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2478 Compliance Determination # 64069 Plan of Correction South Hill Village, Assisted Living & Memory Care Completion Date Page 5 of 6 Licensee: PSL Associates, LLC 08/13/2025 Review of personnel records for Staff A, Care Partner, showed a hire date of 09/04/2024. Further review showed they completed dementia specialty training on 03/05/2025, 182 days after their date of hire, and mental health specialty training on 02/21/2025, 170 days after their date of hire. An observation on 08/08/2025 at 11:42 AM showed Staff A pushing multiple residents in their wheelchairs to the facility dining room. Staff B Review of personnel records for Staff B, Care Partner, showed a hire date of 08/28/2024. Further review showed they completed dementia specialty training on 02/19/2025, 175 days after their date of hire, and mental health specialty training on 02/20/2025, 176 days after their date of hire. An observation on 08/08/2025 at 11:58 AM, showed Staff B serving meals to residents in the facility dining room. Staff C Review of personnel records for Staff C, Care Partner, showed a hire date of 09/11/2024. Further review showed they completed dementia specialty training on 03/18/2025, 188 days after their date of hire, and mental health specialty training on 03/19/2025, 189 days after their date of hire. An observation on 08/08/2025 at 12:17 PM, showed Staff C serving meals to residents in the facility dining room. <Basic Training> Staff C Review of personnel records for Staff C, showed they completed basic training on 04/09/2025, 210 days after their date of hire. Staff E Review of personnel records for Staff E, Care Partner, showed a hire date of 03/28/2023. Further review showed they completed basic training on 01/05/2025, 649 days after their date of hire. An observation on 08/08/2025 at 10:50 AM, showed Staff E escorting Resident 9 in a wheelchair to their room. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2478 Compliance Determination # 64069 Plan of Correction South Hill Village, Assisted Living & Memory Care Completion Date Page 6 of 6 Licensee: PSL Associates, LLC 08/13/2025 <Home Care Aide Certification> Review of personnel records for Staff E, showed they did not have their HCA certification, 811 days since their date of hire. In an interview on 08/12/2025 at 1:45 PM, Staff F, Memory Care Director, confirmed that Staff E did not have their HCA certification. In an interview on 08/13/2025 at 10:58 AM, Staff F stated that it was their responsibility to ensure staff completed specialty training and 70-hour basic training within 120 days of their hire date. Staff F further acknowledged that Staff A, B, C, and E had not completed their required trainings. 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, South Hill Village, Assisted Living & Memory Care 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.

—: WA DSHS report: Inspections (02/2024)