Avamere at Englewood Heights.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEAL TH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Yakima Operations, LLC Avamere at Englewood Heights 371 0 Kern Way Yakima, WA 98902 RE: Avamere at Englewood Heights License# 2460 Dear Administrator: This letter addresses Compliance Determination(s) 61096 (Completion Date 06/13/2025) and 56316 (Completion Date 04/10/2025). The Department completed a follow-up inspection of your Assisted Living Facility on 06/13/2025 and found no deficiencies. Your facility meets the Assisted Living Facility licensing requirements. The Department found that deficiencies for the following licensing laws and regulations were corrected: WAC 388-78A-2600-2-f The Department staff who did the on-site verification: Tracy Ramirez, Assisted Living Facility Licensor If you have any questions, please contact me at (509)208-5231. Sincerely, Laura Williams-Davis, ALF Field Manager Region 1, Unit G Residential Care Services This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Avamere at Englewood Provider Type: Assisted Living Facility Heights License/Cert.#: 2460 Intake ID: 170331 Compliance Determination #: 56316 Region/Unit #: RCS Region 1 / Unit G Investigator: Tracy Ramirez Investigation Date(s): 03/17/2025 through 04/10/2025 Complainant Contact Date(s): Allegation(s): 1. The facility staff performed Cardio-Pulmonary Resuscitation on the named resident when they were a Do Not Attempt Resuscitation. 2. The facility did not honor the named resident’s contract and needs to be clearer if cost may raise. Investigation Methods: Sample: Total residents: 66 Resident sample size: 9 Closed records sample size: 0 Observations: Residents Activities Dining Resident rooms Staff to resident interactions Resident to resident interactions Facility common areas. Interviews: Nursing staff Residents Family members Administrator Record Reviews: Medical records Incident investigation Resident Agreement (contracts) Facility policies Personnel files Electronic mail Investigation Summary: 1. Interviews and record reviews showed that the facility staff performed Cardio-Pulmonary Resuscitation on the named resident when they were a Do Not Attempt Resuscitation. Interviews and record review showed that the facility did not follow their policies and procedures. Failed practice identified. Refer to Washington This document was prepared by Residential Care Services for the Locator website. Administrative Code (WAC) 388-78A-2600 (2)(f) Policies and Procedures. 2. Interviews and record reviews showed that the facility is attempting to resolve the financial concerns. Record review of the named resident’s contract showed that the facility would give 30-day notice when costs may rise. No failed practice identified. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Statement of Deficiencies License #: 2460 Compliance Determination# 56316 Plan of Correction Avamere at Englewood Heights Completion Date Page 1 of 5 Licensee: Yakima Operations, LLC 04/10/2025 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 and complaint investigation on 03/17/2025, 03/18/2025, 03/19/2025 and 03/20/2025 of: Avamere at Englewood Heights 371 0 Kern Way Yakima, WA 98902 This document references the following complaint numbers: 170331. The following sample was selected for review during the unannounced on-site visit: 9 of 66 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Elaine Lopez, Licensor Tracy Ramirez, Assisted Living Facility Licensor From: DSHS, Aging and Long-Term Support Administration Residential Care Services, Region 1 , Unit G 1200 Alder Street Union Gap, WA 98903 This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2460 Compliance Determination # 56316 Plan of Correction Avamere at Englewood Heights Completion Date Page 2 of 5 Licensee: Yakima Operations, LLC 04/10/2025 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. SJ~ 19&, IDR PM for Reg 1G May 22, 2025 Residential Care Services Date I understand that to maintain an Assisted Living Facility license, the facility must be in compliance w· all the licensing laws and regulations at all times. Date WAC 388-78A-26 O Policies and procedures. (2) The assisted living facility must develop, implement and train staff persons on policies and procedures to address what staff persons must do: (f) In response to medical emergencies; This requirement was not met as evidenced by: Based on interview and record review, the Assisted Living Facility failed to ensure staff followed their policies and procedures regarding life-sustaining treatments for 1 of 1 resident (Resident 10). This failed practice had resulted in Resident 10 receiving life saving measures when they were a Do Not Attempt Resuscitation. Findings included ... Review of the facility's policy, "Residency and Move-In Process and Procedure," revised 12/2023, showed that the facility was to copy any forms of healthcare directives including but not limited to living wills, Portable Orders for Life-Sustaining Treatments (POLST), advance directives, and then would place into the residents' records. Review of the facility's Disclosure of Services, undated, showed that the facility would support any advanced directives residents had regarding end-of-life decisions. Review of Resident 10's Resident Agreement, signed and dated 04/30/2024, showed that the facility would honor advance directives/POLST forms. Review of Resident 10's POLST form, dated 10/07/2023, showed that the resident was a This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2460 Compliance Determination# 56316 Plan of Correction Avamere at Englewood Heights Completion Date Page 3 of5 Licensee: Yakima Operations, LLC 04/10/2025 Do Not Attempt Resuscitation (DNAR)/Allow Natural Death code status in an event the individual had no pulse and was not breathing. Review of Resident 10's Admission Record profile, dated 05/01/2024, showed that the resident was a DNAR under the advance directions section. Review of Resident 1 O's Negotiated Service Agreement, dated 11/21/2024, showed that the resident had diagnoses of and . Review of a facility incident report dated /2025, showed that Resident 10 was unresponsive, staff called 911 and was instructed to perform Cardio-Pulmonary Resuscitation (CPR), staff (no identification of staff) looked for the resident's code status paperwork on their refrigerator and was blank, the staff (no identification of staff) proceeded to do CPR until the Emergency Medical Technicians (EMT) arrived. The EMTs asked Resident 10's spouse if they had a DNAR and the spouse said they did, the spouse told the EMTs if they didn't perform CPR on the resident then they would do it themselves and the EMTs continued with CPR and life saving measures until they got a heartbeat and transported the resident to the hospital. Review of Resident 10's progress notes, dated /2025, showed that facility Staff B, Health Services Director, Registered Nurse (RN), had called the hospital and received report that the resident had passed away with family at the bedside. Review of the hospital note dated /2025, for Resident 10, showed that they had sustained a cardiac arrest. In an interview on 03/18/2025 at 8:22 AM, Collateral Contact 1 {CC1), Durable Power of Attorney, stated that Resident 10 was a DNAR, the facility had it on file, and that staff performed CPR on the resident. CC1 stated that they were made aware of Resident 10's spouse's request for staff to perform CPR on Resident 10 and felt the staff did not know the protocol for an unexpected death. In an interview on 03/20/2025 at 10:39 AM, Collateral Contact 2 (CC2), resident's spouse, stated that they were satisfied that the staff followed CC2's wishes of performing CPR on Resident 10. CC2 stated, "I like the staff a lot and they really do a great job." In an interview on 03/25/2025 at 9:42 AM, Staff B, RN, stated that they had informed Resident 10's family that the staff had performed CPR on the resident due to the spouse being adamant with staff to do so, although the resident was DNAR. Staff B stated that This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License #: 2460 Compliance Determination# 56316 Plan of Correction Avamere at Englewood Heights Completion Date Page 4 of 5 Licensee: Yakima Operations, LLC 04/10/2025 this was an unusual situation, and the spouse had stated to staff they would do the CPR themselves if staff did not on Resident 1 0, in addition, staff were worried the spouse could get hurt in the process, so staff followed the instructions of 911 and the spouse. In an interview on 04/09/2025 at 2:28 PM, Staff H, Medication Technician (MT), stated that they had immediately called 911 and were instructed to perform CPR based off Resident 10 having no pulse and was not breathing. Additionally, Staff H stated that there was a blank POLST with no instructions tor staff to follow that the other staff found in the resident's apartment. In an interview on 04/10/2025 at 8:36 AM, Staff I, MT, stated that they were aware that Resident 10 was a DNAR. Staff I stated that the facility keeps copies of POLST forms on residents' refrigerators, inside resident charts in addition to having code status stickers on the outside of the charts, code status on the Medication Administration Records, in their profile page in the electronic medical record, and they also had a binder in the medication room with all residents' code status for staff to follow. In an interview on 04/10/2025 at 1: 13 PM, Staff J, Caregiver, stated that they had immediately called for the MT after finding Resident 10 laying on the floor unresponsive. Staff J stated that the MT immediately arrived, called 911, then Resident 10 had no pulse and was not breathing, 911 instructed them to perform CPR. Staff J stated that they had found a POLST form on the refrigerator and it was blank with no instructions for Resident 1 O's code status. Staff J stated that they had asked Resident 10's spouse if the resident was a DNAR, they responded yes and was adamant that they perform CPR or that the spouse would do it themselves. In an interview on 04/10/2025 at 10:08 AM, Staff A, Administrator and Staff B, RN, stated that they were aware of some confusion about if the POLST form was on the refrigerator or not and is unclear if it was at the time of Resident 10's incident. Staff B stated that it is standard that the POLST forms are located on the residents' refrigerators. Staff B stated that the residents' code status is also in their electronic records. Staff A acknowledged what Staff B had stated. This is a recurring deficiency previously cited on 11/03/2023. This document was prepared by Residential Care Services for the Locator website. Statement of Deficiencies License#: 2460 Compliance Determination# 56316 Plan of Correction Avamere at Englewood Heights Completion Date Page 5 of5 Licensee: Yakima Operations, LLC 04/10/2025 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, Avamere at i=nnl~wnod Heights CJ!5,~~_ . is or will be in compliance with this law and/ or regulation on (Date) plement a system to monitor and ensure continued compliance with Date This document was prepared by Residential Care Services for the Locator website. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 AMENDED 05/22/2025 Yakima Operations, LLC Avamere at Englewood Heights 3710 Kern Way Yakima, WA 98902 RE: Avamere at Englewood Heights # 2460 Dear Administrator: This document references the following complaint numbers 170331. The Department completed a full inspection and complaint investigation of your Assisted Living Facility on 04/10/2025 and found that your facility does not meet the Assisted Living Facility requirements. You requested an Informal Dispute Resolution (IDR) review. The IDR review resulted in the enclosed amended Statement of Deficiencies. The Department: • Wrote the enclosed report; and • May take licensing enforcement action based on many deficiency listed on the enclosed report; and • May inspect your program to determine if you have corrected all deficiencies; and • Expects all deficiencies to be corrected within the timeframe accepted by the department. You Must: • Begin the process of correcting the deficiency or deficiencies immediately; • Contact the Field Manager for clarifications related to the Statement of Deficiencies (SOD); • Within 10 calendar days after you receive this letter, complete and return the enclosed 'Plan/Attestation Statement'; o Sign and date the enclosed report; o For each deficiency, indicate the date you have or will correct each deficiency; o Return the Plan/Attestation Statement and report with signatures to: This document was prepared by Residential Care Services for the Locator website. Avamere at Englewood Heights # 2460 04/10/2025 Page 2 of 3 Laura Williams-Davis, ALF Field Manager Residential Care Services Region 1, Unit G Preferred methods: eFax: (509) 454-4160 Email: rcsregion1email@dshs.wa.gov Optional method: 1200 Alder Street Union Gap, WA 98903 • Complete correction(s) within 45 days, or sooner if directed by the Department, after review of your proposed correction dates. • Have your plan approved by the Department. Consultation(s): In addition, the Department provided consultation on the following deficiency or deficiencies not listed on the enclosed report. WAC 388-78A-2620 Pets. If an assisted living facility allows pets to live on the premises, the assisted living facility must: (2) Ensure animals living on the assisted living facility premises: (a) Have regular examinations and immunizations, appropriate for the species, by a veterinarian licensed in Washington state; (b) Are certified by a veterinarian to be free of diseases transmittable to humans; The Assisted Living Facility failed to ensure residents’ pets at the facility had regular examinations and immunizations. The facility corrected by ensuring one of the pets had been seen by their veterinarian and scheduled an appointment for the other pet. WAC 388-78A-2474 Training and home care aide certification requirements. (2) The assisted living facility must ensure all assisted living facility administrators, or their designees, and caregivers hired on or after January 7, 2012 meet the long-term care worker training requirements of chapter 388-112A WAC, including but not limited to: (c) Specialty for dementia, mental illness and/or developmental disabilities when serving residents with any of those primary special needs; The Assisted Living Facility failed to ensure staff who worked unsupervised with residents completed the dementia and mental health specialty training within the required time frame. The facility acknowledged that staff completed the training late, would develop a plan to ensure trainings were completed on time, and scheduled one of This document was prepared by Residential Care Services for the Locator website. Avamere at Englewood Heights# 2460 04/10/2025 Page 3 of3 the staff to obtain their training. The deficiency was corrected on-site at the time of the visit. You Are Not: • Required to submit a plan of correction for the consultation deficiency or deficiencies stated in this letter and not listed on the enclosed report. You May: • Contact me for clarification of the deficiency or deficiencies found. If You Have Any Questions: • Please contact me at (509)208-5231. Sincerely, SJ~!!)~ , IDR PM for Laura Williams-Davis Laura Williams-Davis, ALF Field Manager Region 1, Unit G Residential Care Services Enclosure This document was prepared by Residential Care Services for the Locator website. Plan of Correction Agency Name Citation Date Avamere 04/10/2025 Submitted by Date of POC Submission Abiel Paz 05/01/2025-06/06/2025 'S( □ Complaint Citation Certification Citation Citation: (list WAC) 388-78A-2600 What initial or immediate Following the incident, the facility will conduct an in-service of emergency actions were taken to address medical-response procedures. Staff will be educated how to access POLST concerns affecting clients? forms during emergency responses. POLST audit is under review. How will you apply the Conducting a facility wide audit of all POLST forms for current residents to correction to all clients you ensure availability during emergencies. All direct care and med tech staff support? will receive in-service training to reinforce procedures and protocols related to emergencies and POLST accessibility. Who will be responsible to Executive Director Abiel Paz implement change and monitor Director of Health, Mirella Gould the corrections to ensure the problems do not reoccur? Date by which lasting Audit will be conducted for current residents in the facility. Starting May correction will be achieved ist, 2025 and ending May 31st . Click here to enter a date. Additional Information This Plan of Correction is submitted in good faith while an Informal Dispute Resolution (IDR) is being filed for this citation. The facility believes its staff acted in compliance with policy and state expectations under emergency conditions, and this POC represents proactive reinforcement of existing protocols. This is the original Plan of correction, amended SOD on 5/22/2025, we will utilize the same POC. Submit to RCS within 10 calendar days of receipt of letter to: Nicole Vreeland, Field Manager Residential Care Services PO Box 45600 Olympia, WA 98504-5600 Fax: (360) 725-3208 Vree1NL@dshs.wa.gov Send copy to DDA Resource Manager or Residential Program Specialist for your region. This document was prepared by Residential Care Services for the Locator website.

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Home and Community Living Administration Residential Care Services • RCSIDR@dshs.wa.gov May 22, 2025 (email) Yakima Operations, LLC Avamere at Englewood Heights 3710 Kern Way Yakima, WA 98902 IDR RESULTS ALF #2460 Dear Provider: Thank you for participating in the Informal Dispute Resolution (IDR) process. During the IDR we addressed your disputes identified in your IDR Request in response to the Statement of Deficiencies (SOD) report dated April 10, 2025. As discussed during the IDR, the following information was considered: • All materials presented by the Assisted Living Facility ; • All oral statements and explanations offered by the Assisted Living Facility; • Records gathered by the Residential Care Services (RCS) regional staff. After careful review and consideration, I have decided to make the following change to the SOD identified above: WAC 388-78A-2600 – No Change WAC 388-78A-2980 – Deleted Next Steps: • Review the attached amended cover letter and SOD reflecting the change noted above. • Follow instructions according to the cover letter to the SOD. Note: The length of time for completion and posting of final documents to the DSHS locator, including amended documents, will vary. If you are looking for specific information not currently posted, please contact pdd@dshs.wa.gov. If you have any questions, please contact me at staci.dilg@dshs.wa.gov. Sincerely, Staci Dilg IDR Program Manager Residential Care Services cc: Regional Administrator, Region 1 Field Manager, Region 1 Unit G Statewide and Regional Long Term Care Ombudsman Central File IDR File

STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Aging and Long Term Support Administration Residential Care Services Division • RCSIDR@dshs.wa.gov • Fax 360-725-3225 May 5, 2025 (email) Abiel Paz-Administrator Avamere at Englewood Heights 3710 Kern Road Yakima, WA 98902 TRADITIONAL IDR SCHEDULING LETTER VIRTUAL-VIDEO ENABLED AND DOCUMENT REVIEW License #2460 Dear Administrator: This letter will confirm your request for an Informal Dispute Resolution (IDR) regarding the Statement of Deficiencies (SOD) dated April 10, 2025. Per our conversation, Staci Dilg, will meet with you virtually on May 15, 2025 at 1:30 for WAC 388-78A-2600. Please enable your video for your review. You may join through your invitation that was sent to you on May 5, 2025. If you have difficulty logging on, you may call 1-564-999-2000 using conference ID 757 568 82# to join the meeting. You indicated you are disputing the following citation(s): WAC 388-78A-2600 conducted Virtually/with Video Enabled and WAC 388-78A- 2980 using Document Review only You indicated the following individuals will participate and represent your facility in the IDR process for WAC 388-78A-2600: Abiel Paz-Administrator, Melissa Reynolds-Regional Nurse, Mirella Gould- Director of Health Services If you haven’t already done so, please provide additional documentation specifically related to the citation(s) you are disputing, at least one week prior to the scheduled IDR date, by emailing them to RCSIDR@dshs.wa.gov, or by faxing them to (360) 725-3225. If you have any questions, please contact us at RCSIDR@dshs.wa.gov . Sincerely, Kim Friesz Kim Friesz Administrative Assistant 3 IDR Program Residential Care Services Enclosure cc: Regional Administrator, Region 1 Field Manager, Region 1 Unit G State and Regional Ombuds Field File Central Files IDR File

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Avamere at Englewood Provider Type: Assisted Living Facility Heights License/Cert.#: 2460 Intake ID: 94917 Compliance Determination #: 29695 Region/Unit #: RCS Region 1 / Unit G Investigator: Lucinda Vautour Investigation Date(s): 09/18/2023 through 11/03/2023 Complainant Contact Date(s): 11/06/2023 Allegation(s): The named resident fell and waited 55 minutes for assistance to arrive, Investigation Methods: Sample: Total residents: 58 Resident sample size: 58 Closed records sample size: 1 Observations: Environment Cares Named Resident Residents Facility response time to resident concerns Interviews: Named resident Facility staff Others not associated with the facility Record Reviews: Named resident's record Facility Policy's Emergency Call Log Investigation Summary: Observations, interviews and record reviews showed that the facility failed to respond to the named resident's calls for assistance timely as facility policy and the Department required. Failed facility practice found. WAC 388-78A-2600 1A and 2F Policies. Reference statement of deficiencies dated 11/03/2023. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Avamere at Englewood Provider Type: Assisted Living Facility Heights License/Cert.#: 2460 Intake ID: 99921 Compliance Determination #: 29695 Region/Unit #: RCS Region 1 / Unit G Investigator: Lucinda Vautour Investigation Date(s): 09/18/2023 through 11/03/2023 Complainant Contact Date(s): 10/27/2023 Allegation(s): 1. A named resident was charged by the facility for rent and care after they were discharged from the facility. 2. Facility staff was not delegated to administer Insulin to the named resident. 3. A named resident called for staff assistance on 8/3/2023 and waited for an extended amount of time and was found on a chair sitting in bowel movement. 4. A named resident's bed sheets not changed by staff. 5. A named staff member argued with a named resident about receiving Insulin. 6. A named resident fell twice and waited an extended amount of time for staff assistance. 7. A named resident is missing towels, bedding and clothing. 8. A named resident was not given their acid reflux medication. Investigation Methods: Sample: Total residents: 58 Resident sample size: 58 Closed records sample size: 1 Observations: Environment Cares Residents Resident apartments Facility staff response to resident needs Interviews: Residents Facility staff Others not associated with the facility Record Reviews: Named resident's record Facility policy's Emergency Call Log Investigation Summary: Observations, interviews and record reviews showed: 1. The named resident was charged by the facility for rent and care after they were discharged from the facility and the facility reversed the charges. No failed facility This document was prepared by Residential Care Services for the Locator website. practice found. 2. The facility does not complete delegated tasks and the resident, resident family were aware prior to admission to the facility. No failed facility practice found. 3. and 6. A named resident called for staff assistance when they fell and on 8/3/2023 and waited for an extended amount of time and was found on a chair sitting in bowel movement. The facility failed to respond timely to the named resident's calls for assistance as facility policy and the Department required. WAC 388-78A-2600 1A and 2F, Policies, 4. Resident's apartments were observed to be clean and tidy, garbage removed and bedding clean. No failed facility practice found. 5. The named resident received their Insulin by their family and a named staff member discussed the need for Insulin administration with the named resident to ensure a medication error was not made. No failed facility practice found. 7. The facility was informed of missing belongings of the named resident and began a search and returned items found to the resident. No failed facility practice found. 8. The named resident was administered all medications ordered by their physician. No failed facility practice found. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Avamere at Englewood Provider Type: Assisted Living Facility Heights License/Cert.#: 2460 Intake ID: 103298 Compliance Determination #: 29695 Region/Unit #: RCS Region 1 / Unit G Investigator: Lucinda Vautour Investigation Date(s): 09/18/2023 through 11/03/2023 Complainant Contact Date(s): 11/06/2023 Allegation(s): 1. A named resident was charged by the facility for rent and care after they were discharged from the facility. 2. Facility staff did not order medications timely and the staff were not delegated to administer Insulin to the named resident. 3. A named resident called for staff assistance on 8/3/2023 and waited for an extended amount of time and was found on a chair sitting in bowel movement. 4. A named resident's bed sheets not changed by staff. 5. A named staff member argued with a named resident about receiving Insulin. 6. A named resident fell twice and waited an extended amount of time for staff assistance. 7. A named resident is missing towels, bedding and clothing. 8. A named resident was not given their acid reflux medication. Investigation Methods: Sample: Total residents: 58 Resident sample size: 58 Closed records sample size: 1 Observations: Environment Cares Residents Resident apartments Facility staff response to resident needs Interviews: Residents Facility staff Others not associated with the facility Record Reviews: Named resident's record Facility policy's Emergency Call Log Investigation Summary: Observations, interviews and record reviews showed: 1. The named resident was charged by the facility for rent and care after they were This document was prepared by Residential Care Services for the Locator website. discharged from the facility and the facility reversed the charges. No failed facility practice found. 2. The facility does not complete delegated tasks and the resident, resident family were aware prior to admission to the facility. No failed facility practice found. 3. and 6. A named resident called for staff assistance when they fell and on 8/3/2023 and waited for an extended amount of time and was found on a chair sitting in bowel movement. The facility failed to respond timely to the named resident's calls for assistance as facility policy and the Department required. WAC 388-78A-2600 1A and 2F, Policies 4. Resident's apartments were observed to be clean and tidy, garbage removed and bedding clean. No failed facility practice found. 5. The named resident received their Insulin by their family and a named staff member discussed the need for Insulin administration with the named resident to ensure a medication error was not made. No failed facility practice found. 7. The facility was informed of missing belongings of the named resident and began a search and returned items found to the resident. No failed facility practice found. 8. The named resident was administered all medications ordered by their physician. No failed facility practice found. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Avamere at Englewood Provider Type: Assisted Living Facility Heights License/Cert.#: 2460 Intake ID: 101200 Compliance Determination #: 29695 Region/Unit #: RCS Region 1 / Unit G Investigator: Lucinda Vautour Investigation Date(s): 09/18/2023 through 11/03/2023 Complainant Contact Date(s): Allegation(s): The facility had not notified Construction Review Services (CRS) of planned and implemented modifications to the ALF’s physical structure other than a cooler being replaced. Investigation Methods: Sample: Total residents: 58 Resident sample size: 58 Closed records sample size: 1 Observations: The facility’s dining room, kitchen, mobile kitchen were observed. Interviews: Facility staff and others not associated with the facility. Record Reviews: Resident characteristic roster. Investigation Summary: Observations and interviews with facility staff and others not associated with the facility, showed that the facility did not notify the required department of planned and implemented modifications to the facility’s physical structure. Determined failed practice WAC 388-78A-2850 Required review of building plans. Statement of Deficiency (SOD) 11/03/2023. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website.

This document was prepared by Residential Care Services for the Locator website. Residential Care Services Investigation Summary Report Provider/Facility: Avamere at Englewood Provider Type: Assisted Living Facility Heights License/Cert.#: 2460 Intake ID: 78363 Compliance Determination #: 22934 Region/Unit #: RCS Region 1 / Unit G Investigator: Tracy Ramirez Investigation Date(s): 04/17/2023 through 04/25/2023 Complainant Contact Date(s): 04/17/2023, 04/26/2023 Allegation(s): 1. The facility did not explain the process for transferring and or help with the named resident’s steps while they had received rehabilitation at a skilled nursing facility. 2. The facility had not allowed the named resident’s responsible party to be present in a meeting to determine if the named resident would be able to return. 3. The facility had denied the named resident to return to the facility without seeing them. 4. The facility had charged the named resident while out of the facility. Investigation Methods: Sample: Total residents: 50 Resident sample size: 7 Closed records sample size: 0 Observations: The facility’s common areas, resident rooms, resident to resident and staff to resident interactions were observed. Interviews: Facility staff, sampled residents, and others not associated with the facility. Record Reviews: Resident characteristic roster, resident records (face sheets, care plans, progress notes, medication administration records, temporary service plans (TSPs), physician faxes, hospital notes, outside providers notes, resident agreement, incident/investigations, billing statements) and the facility’s resident handbook. Investigation Summary: 1. The facility communicated with the named resident’s responsible party via a documented telephone conversation. 2. The facility communicated directly with the skilled nursing facility (SNF) regarding residents’ progress in their rehabilitation to determine if able to return to the facility. 3. The ALF had determined that they would not be able to meet the named resident’s needs based off the SNF’s therapy notes, progress notes. 4. The facility charged for care and services that the resident did not receive. Failed practice identified WAC 388-78A-2660. Reference Statement of Deficiencies This document was prepared by Residential Care Services for the Locator website. (SOD) 04/25/2023. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A This document was prepared by Residential Care Services for the Locator website. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION 1200 Alder Street, Union Gap, WA 98903 Yakima Operations, LLC Avamere at Englewood Heights 3710 Kern Way Yakima, WA 98902 RE: Avamere at Englewood Heights # 2460 Dear Administrator: This document references the following complaint numbers 78363, 77073. The Department completed a full inspection of your Assisted Living Facility on 04/25/2023 and found that your facility does not meet the Assisted Living Facility requirements. The Department: • Wrote the enclosed report; and • May take licensing enforcement action based on many deficiency listed on the enclosed report; and • May inspect your program to determine if you have corrected all deficiencies; and • Expects all deficiencies to be corrected within the timeframe accepted by the department. You Must: • Begin the process of correcting the deficiency or deficiencies immediately; • Contact the Field Manager for clarifications related to the Statement of Deficiencies (SOD); • Within 10 calendar days after you receive this letter, complete and return the enclosed 'Plan/Attestation Statement'; o Sign and date the enclosed report; o For each deficiency, indicate the date you have or will correct each deficiency; o Mail the Plan/Attestation Statement and report with original signatures to: Gwin Kaercher, Field Manager Residential Care Services This document was prepared by Residential Care Services for the Locator website. Avamere at Englewood Heights # 2460 04/25/2023 Page 2 of 3 Region 1, Unit G 1200 Alder Street Union Gap, WA 98903 • Complete correction(s) within 45 days, or sooner if directed by the Department, after review of your proposed correction dates. • Have your plan approved by the Department. Consultation(s): In addition, the Department provided consultation on the following deficiency or deficiencies not listed on the enclosed report. WAC 388-78A-2620 Pets. If an assisted living facility allows pets to live on the premises, the assisted living facility must: (2) Ensure animals living on the assisted living facility premises: (a) Have regular examinations and immunizations, appropriate for the species, by a veterinarian licensed in Washington state; The Assisted Living Facility failed to maintain regular immunizations for a pet in the facility. WAC 388-78A-2305 Food sanitation. The assisted living facility must: (2) Ensure employees working as food service workers obtain a food worker card according to chapter 246-217 WAC; and The Assisted Living Facility failed to ensure an employee working as a food service worker maintained their food worker card. You Are Not: • Required to submit a plan of correction for the consultation deficiency or deficiencies stated in this letter and not listed on the enclosed report. You May: • Contact me for clarification of the deficiency or deficiencies found. In Addition, You May: • Request an Informal Dispute Resolution (IDR) review within 10 working days after you receive this letter. Your IDR request must include: o What specific deficiency or deficiencies you disagree with; o Why you disagree with each deficiency; and o Whether you want an IDR to occur in-person, by telephone or as a paper review. o Send your request to: This document was prepared by Residential Care Services for the Locator website. Avamere at Englewood Heights # 2460 04/25/2023 Page 3 of 3 IDR Program Manager Department of Social and Health Services Aging and Long-Term Support Administration Residential Care Services PO Box 45600 Olympia, WA 98504-5600 If You Have Any Questions: • Please contact me at (509)208-5231. Sincerely, Gwin Kaercher, Field Manager Region 1, Unit G Residential Care Services Enclosure This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website.