Deficiencies per Year
16
12
8
4
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Life Safety
Deficiencies: 13
Jul 23, 2025
Visit Reason
The Office of the State Fire Marshal conducted an inspection at the facility to assess compliance with fire safety and life safety code requirements.
Findings
The facility was found to have multiple violations including failure to maintain kitchen oven power supply, lack of documentation for cleaning and maintenance of fire safety equipment, failure to provide annual inspection reports for fire doors, and issues with emergency lighting and fire alarm testing. The facility was disapproved due to these deficiencies.
Deficiencies (13)
| Description |
|---|
| Facility failed to maintain kitchen oven, oven is plugged into a power strip. |
| Facility failed to provide documents showing kitchen hood is being cleaned twice a year. |
| Facility failed to provide annual report that all fire-resistance-rated construction is being inspected (fire wall inspection). |
| Back wall of 1st communications room has electrical conduit with no fire rated caulking. |
| Fire/smoke damper report from 9/7/22 shows dampers that failed; facility needs to provide report that dampers have been fixed. |
| Facility failed to provide documentation for fire sprinkler system testing including five-year internal pipe inspection, three-year dry system full flow trip test, and five-year fire department connection hydrostatic test. |
| Fire sprinkler head outside of room 18 in memory care is loaded with debris. |
| Facility failed to provide fire alarm reports including fire alarm sensitivity test and monthly inspection of fire alarms with batteries. |
| Facility failed to provide report showing testing and maintenance of carbon monoxide detectors. |
| Facility failed to provide documentation showing monthly 30 second test of exits and emergency lights. |
| Facility failed to provide documentation showing annual 1.5 hour test of exits and emergency lights. |
| Facility failed to provide annual inspection report for fire doors. |
| Double doors by puzzle table on 3rd floor failed to latch. |
Report Facts
Date of inspection: Jul 23, 2025
Next inspection scheduled: Aug 30, 2025
Duration of emergency lighting test: 30
Duration of battery-powered emergency lighting test: 90
Duration of annual emergency lights test: 1.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| William H. Arnold Jr. | M.D. | Owner or Authorized Representative who signed the inspection report |
| Raul Murcia | Deputy State Fire Marshal | Official who conducted the inspection and signed the report |
Inspection Report
Follow-Up
Census: 102
Capacity: 102
Deficiencies: 1
Mar 5, 2025
Visit Reason
The Department completed a follow-up inspection of the Assisted Living Facility to verify correction of previously cited deficiencies.
Findings
The follow-up inspection found no deficiencies and confirmed the facility meets Assisted Living Facility licensing requirements. The prior deficiency related to tuberculosis testing compliance was corrected.
Deficiencies (1)
| Description |
|---|
| Failure to ensure 1 of 4 sampled staff had tuberculosis skin test within three days of employment. |
Report Facts
Residents present: 102
Total capacity: 102
Sampled staff: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cory Myers | ALF Complaint Investigator | Conducted off-site verification and inspection |
| Cathleen Davis | ALF Licensor | Inspected the Assisted Living Facility |
| Jody Just | Field Services Administrator | Signed the follow-up inspection letter |
Inspection Report
Life Safety
Deficiencies: 8
Jul 2, 2024
Visit Reason
The Office of the State Fire Marshal conducted a fire safety inspection at the facility on July 2, 2024.
Findings
The facility was disapproved due to multiple fire safety violations including failure to provide documentation for cleaning kitchen hoods, annual fire-resistance construction inspection, damper repairs, fire sprinkler system maintenance, monthly emergency lighting tests, and annual fire door inspections. Specific physical deficiencies such as a painted sprinkler head, missing escutcheon ring, blocked sprinkler head, and a fire door that does not latch were noted.
Deficiencies (8)
| Description |
|---|
| Facility failed to provide documentation showing kitchen hood is being cleaned twice a year. |
| Facility failed to provide documentation showing annual inspection of all fire-resistance-rated construction (fire wall inspection). |
| Damper report states failed dampers, facility shall provide documentation that dampers were fixed. |
| Facility failed to maintain fire sprinkler system at multiple locations including painted sprinkler head in room 115, accelerator deficiency in dry system, no annual fire pump inspection, missing escutcheon ring in coffee shop, and blocked sprinkler head in dry storage. |
| Facility failed to provide documentation showing monthly inspection of single and multiple station smoke alarms. |
| Facility failed to provide documentation showing monthly 30 second inspection of all emergency lights and exit signs. |
| Facility failed to provide documentation showing annual inspection of all fire doors. |
| Second floor, elevator #2 fire door does not latch. |
Report Facts
Next inspection scheduled date: Aug 2, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Raul Murcia | Deputy State Fire Marshal | Conducted the inspection and signed the report |
Inspection Report
Complaint Investigation
Census: 83
Deficiencies: 1
Dec 8, 2023
Visit Reason
The Department completed a complaint investigation of the Assisted Living Facility due to allegations that the facility did not meet Assisted Living Facility requirements, specifically related to quality of care when a resident was found on the floor after a fall and required medical treatment.
Findings
The investigation found that a resident fell in their room, striking their head and requiring hospital treatment. The facility's direct care staff did not have access to the most current interventions in the resident's care plan, constituting a failed practice. Consultation was provided and citations were written for failed provider practice.
Complaint Details
Complaint investigation found the facility failed to provide quality of care when a resident was found on the floor after a fall and required medical treatment. Failed provider practice was identified and citations were written.
Deficiencies (1)
| Description |
|---|
| Direct care staff did not have access to the most current interventions in the resident's care plan, resulting in failed practice. |
Report Facts
Total residents: 83
Resident sample size: 5
Closed records sample size: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Regenia Coleman | Investigator | Department staff who conducted the inspection and provided consultation |
| Manfay Chan | Field Manager | Signed letter regarding the complaint investigation |
Inspection Report
Renewal
Deficiencies: 10
May 18, 2023
Visit Reason
The inspection was conducted by the Office of the State Fire Marshal as a renewal inspection of the licensed Assisted Living Facility, Brookdale MontClair Poulsbo.
Findings
The facility was found to have multiple violations related to fire safety and maintenance, including failure to maintain power strips, extension cords, sprinkler heads, fire alarm system, smoke detector sensitivity tests, carbon monoxide alarms, emergency lighting activation tests, and generator maintenance documentation.
Deficiencies (10)
| Description |
|---|
| Facility failed to maintain power strips in maintenance shop, power strips connected to other power strips. |
| Facility failed to maintain extension cords in maintenance shop, extension cords cannot be used as permanent wiring. |
| Facility failed to maintain sprinkler head located in physical therapy room, sprinkler head recessed. |
| Facility failed to provide documentation showing 2nd semi-annual servicing of kitchen suppression system. |
| Facility failed to provide documentation showing monthly inspection of single and multiple station smoke alarms. |
| Facility failed to maintain fire alarm system, system in trouble mode. |
| Facility failed to provide documentation showing sensitivity test has been conducted on fire alarm system. |
| Facility failed to provide documentation showing carbon monoxide alarms are being tested or maintained. |
| Facility failed to provide documentation showing 30-second monthly activation test of exit signs and emergency lighting. |
| Facility failed to provide documentation for generator annual servicing, log of weekly inspections, and log of monthly 30-minute full load test. |
Report Facts
Next inspection scheduled date: Jun 20, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Raul Murcia | Deputy State Fire Marshal | Signed as the inspector conducting the inspection |
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