Cascade Park Gardens, L.l.c..

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written . N/A . Statement of Deficiencies License #: 2605 Compliance Determination # 59026 Plan of Correction Cascade Park Gardens, L.L.C. 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-2150 Signing negotiated service agreement. The assisted living facility must ensure that the negotiated service agreement is agreed to and signed at least annually by: (1) The resident, or the resident's representative if the resident has one and is unable to sign or chooses not to sign; (2) A representative of the assisted living facility duly authorized by the assisted living facility to sign on its behalf; and (3) Any public or private case manager for the resident, if available. This requirement was not met as evidenced by: Based on interviews and records review, the facility failed to ensure that 2 of 4 sampled residents (Resident 1 [R1] & Resident 2 [R2]) had negotiated service agreements (NSA) signed by the resident or resident’s representative. This failure placed the residents at risk for unmet care needs and lack of resident autonomy. Findings included… Record review of R1’s NSA, undated, showed no signature from resident representative in the section labeled “signature.” Record review of R2’s NSA, undated, showed no signature from resident representative in the section labeled “signature.” In an interview on 05/07/2025 at 12:49PM, Staff A, Resident Care Coordinator, stated that “it can be like pulling teeth to get it [the NSA] signed. I ask that it get emailed . Statement of Deficiencies License #: 2605 Compliance Determination # 59026 Plan of Correction Cascade Park Gardens, L.L.C. Completion Date back, some people never respond.” In an interview on 05/19/2025 at 1:46PM with Staff C, Director of Resident services, when asked if R2 had anything signed within the last 12 months prior to his care conference stated they “did not think so”. In an interview on 05/19/2025 at 1:46PM with Staff B, Executive Director, stated in regards to R1, there was no signature on the documents in question. 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, Cascade Park Gardens, L.L.C. 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 .

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 . . . .