Blossom Creek Senior Alzheimer Community.

This document was prepared by Residential Care Services for the Locator website.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Ii □ □ Investigation Summary Report Provider/Facility: Blossom Creek Senior Provider Type: Assisted Living Facility Alzheimer Community License/Cert.#: 2721 Intake ID: 155718 Compliance Determination #: 50444 Region/Unit #: RCS Region 1 / Unit G Investigator: Brittney Shull Investigation Date(s): 11/19/2024 through 01/23/2025 Complainant Contact Date(s): 01/23/2025 Allegation(s): The named resident was allegedly neglected with concerns of skin integrity, weight loss, and poor hygiene. Investigation Methods: Sample: Total residents: 41 Resident sample size: 3 Closed records sample size: 1 Observations: Residents, Staff to residents interactions, Cares and services, Environment, Staff availability. Interviews: Residents, Staff, Collateral contacts. Record Reviews: Characteristic Roster, Resident Record, Progress Notes, Incident Report and Investigation, Facility Policy, Medical Record. Investigation Summary: Interview and record review showed that the facility completed an investigation and did not substantiate neglect. Interview and record review showed that cares and services were not provided to residents. Interview and record review showed that the named resident had a physical change in their functioning that had been unidentified. Records requested were not initially available to the department for review. Failed practice identified, reference Statement of Deficiencies for WAC 388-78A(2160) and Consultation for WAC 388-78A(2400). Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . I&] □ □ . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Statement of Deficiencies License#: 2721 Compliance Determination # 50444 Plan of Correction Blossom Creek Senior Alzheimer Community 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 11/19/2024 and 12/04/2024 of: Blossom Creek Senior Alzheimer Community 174 0 Madison St Wenatchee, WA 98801-4700 This document references the following complaint number(s): 155718, 157106 The following sample was selected for review during the unannounced on-site visit: 3 of 41 current residents and 1 former residents. The department staff that investigated the Assisted Living Facility: Brittney Shull, Community Complaint Investigator From: DSHS, Aging and Long-Term Support Administration 1200 Alder Street Union Gap, WA 98903 . 02.06.2025 13:11 :54 State of Washington 7/15 Statement of Deficiencies License#: 2721 Compliance Determination # 50444 Plan or Correction Blossom Creek Senior Alztleimer Community Completion Dale Page 2 ot 9 Licensee: AHR Wenatchee WA MC TRS Sub, LLC 01/23/2025 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. 02/06/2025 ------- ----- 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. WAC 388-78A-2160 Implementation of negotiated service agreement. The assisted living facility must provide the care and services as agreed upon in the negotiated service agreement to each resident unless a deviation from the negotiated service agreement is mutually agreed upon between the assisted living facility and the resident or the resident's representative at the time the care or services are scheduled. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure that cares and services were implemented according to each resident's negotiated service agreement for 3 of 4 residents (Resident 1, 2, and 4). This failure resulted in residents not receiving cares and placed them at risk for an undignified experience and potential l1ealth problems. Findings included ... Review of the facility policy titled, "Personal Care and Dressing," dated 12/01/2023 showed that hygiene. personal care and grooming processes should be carried out as addressed by the resident's Negotiated Service Agreements. On 11/19/2024 at 10:02 AM Staff E, Caregiver, stated that oral care was provided daily to residents, in the morning and evening. Staff E stated that showers were given weekly lo residents who needed assistance and skin checks were provided at that time. Staff E stated that staff documented sl1owers on paper in the medication room, where they also documented oral care. Staff E stated that weights were taken monthly for all residents and reported to medication aids who tracked the weights. Food intakes was monitored by telling tt,e kitchen staff what tl1e residents ate. 02/06/2025 . Statement of Deficiencies License#: 2721 Compliance Determination# 50444 Plan of Correction Blossom Creek Senior Alzheimer Community 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-2160 Implementation of negotiated service agreement. The assisted living facility must provide the care and services as agreed upon in the negotiated service agreement to each resident unless a deviation from the negotiated service agreement is mutually agreed upon between the assisted living facility and the resident or the resident's representative at the time the care or services are scheduled. This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility (ALF) failed to ensure that cares and services were implemented according to each resident's negotiated service agreement for 3 of 4 residents (Resident 1, 2, and 4). This failure resulted in residents not receiving cares and placed them at risk for an undignified experience and potential health problems. Findings included ... Review of the facility policy titled, "Personal Care and Dressing," dated 12/01/2023 showed that hygiene, personal care and grooming processes should be carried out as addressed by the resident's Negotiated Service Agreements. On 11/19/2024 at 10:02 AM Staff E, Caregiver, stated that oral care was provided daily to residents, in the morning and evening. Staff E stated that showers were given weekly to residents who needed assistance and skin checks were provided at that time. Staff E stated that staff documented showers on paper in the medication room, where they also documented oral care. Staff Estated that weights were taken monthly for all residents and reported to medication aids who tracked the weights. Food intakes was monitored by telling the kitchen staff what the residents ate. . Statement of Deficiencies License#: 2721 Compliance Determination # 50444 Plan of Correction Blossom Creek Senior Alzheimer Community Completion Date <Resident 1> Review of Resident 1' s Assessment dated 05/08/2024, showed that Resident 1: -Did not have skin breakdown, pressure ulcers, or wounds. -Was incontinent of bladder and bowel and wore adult pull-up/protective underwear. -Had their own teeth Review of Resident 1' s Negotiated Service Agreement, dated 05/08/2024, showed that Resident 1: -Required staff to measure and document monthly weights. -Required 2-person staff assistance, sometimes with the use of a mechanical lift, to transfer or change position 3 times a day to a chair or wheelchair. -Required full staff assistance with bathing once a week on Mondays or Thursdays, in which their skin should be checked. -Required staff assistance with personal hygiene 3 times a day. -Required staff assistance with adult pull-up/protective underwear and peri-care due to incontinence, 3 times a day. -Required staff to check every 2 hours for toileting and safety during the night. -Required staff assistance with meal attendance for breakfast, lunch, dinner. -Required staff assistance to be fed by mouth. -Required staff to provide a nutritional supplement daily. Review of Resident 1's Progress Notes showed that on 11/17/2024, Resident 1 was found at 3 am in distress and sent to the emergency room. Resident 1 returned to the facility the same day with comfort medications and a plan to initiate hospice after the weekend. On /2024, Resident 1 passed away. Review of Resident 1' s Emergency Room Note dated 11/17/2024, showed that Resident 1 was examined at 4:00 AM and was critically ill and likely dehydrated. Resident 1 had dried food in their mouth/teeth, multiple areas of redness on their skin and hips which were consistent with pressure injuries.