Inspection Report
Follow-Up
Census: 68
Deficiencies: 4
Jul 1, 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 that the facility meets the Assisted Living Facility licensing requirements. The prior deficiencies were corrected as listed in the report.
Complaint Details
The inspection was complaint-related as indicated by the involvement of an ALF Complaint Investigator and the nature of deficiencies cited.
Deficiencies (4)
| Description |
|---|
| Failure to complete Washington state name and date of birth background checks upon hire for 5 sampled staff. |
| Failure to document involvement of residents or their representatives in planning care for 4 of 9 sampled residents. |
| Failure to maintain a current characteristic roster accurately documenting resident care needs and services for 5 sampled residents. |
| Failure to complete tuberculosis (TB) testing within 3 days of employment for 2 of 3 sampled staff. |
Report Facts
Sampled residents: 9
Sampled staff: 5
Deficiencies cited: 4
Completion dates: 2
Plan/Attestation signature dates: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kyle Gehlen | ALF Licensor - LTC | Department staff who inspected the Assisted Living Facility. |
| Jennifer Siharath | ALF Licensor | Department staff who inspected the Assisted Living Facility. |
| Richard Westom | NCI, ALF Complaint Investigator | Department staff who inspected the Assisted Living Facility. |
| Clinton Fridley | Adult Family Home Nurse Field Manager | Signed the follow-up inspection letter and enforcement letter. |
| Staff C | Health and Wellness Director | Named in background check and TB testing deficiencies. |
| Staff D | Certified Nursing Assistant (CNA)/Medication Technician | Named in background check deficiency. |
| Staff E | Medication Technician | Named in background check and TB testing deficiencies. |
| Staff F | PRN/Medication Technician | Named in background check deficiency. |
| Staff G | CNA/Medication Technician | Named in background check deficiency. |
| Staff H | Business Office Manager | Interviewed regarding background check requirements. |
| Staff A | Executive Director | Acknowledged deficiencies during exit interview. |
Inspection Report
Re-Inspection
Deficiencies: 4
Mar 5, 2025
Visit Reason
The Office of the State Fire Marshal conducted a re-inspection at the facility to verify correction of previously cited fire safety violations.
Findings
The facility failed to provide fire door inspection reports for all fire doors, had fire doors with excessive gaps, and a damaged kitchen door. Additionally, signage related to locking arrangements was missing or outdated.
Deficiencies (4)
| Description |
|---|
| Facility failed to provide fire door inspection report for all fire doors (missing resident room doors). |
| Fire doors found throughout with excessive gaps. |
| Claire bridge studio kitchen door found damaged. |
| Signage shall be installed/updated in accordance with locking arrangement. |
Report Facts
Next inspection scheduled date: Apr 4, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nick Fletcher | Owner or Authorized Representative | Signed the re-inspection report on 3/28/2025 |
| Nicholas Wolden | Deputy State Fire Marshal | Signed the re-inspection report |
Inspection Report
Re-Inspection
Deficiencies: 4
Mar 5, 2025
Visit Reason
The Office of the State Fire Marshal conducted a re-inspection at the facility to verify correction of previously cited violations related to fire safety and maintenance.
Findings
The facility failed to provide fire door inspection reports for all fire doors, with missing resident room doors noted. Fire doors were found throughout with excessive gaps, and the Claire Bridge studio kitchen door was found damaged. Signage related to locking arrangements was also found lacking or needing updates.
Deficiencies (4)
| Description |
|---|
| Facility failed to provide fire door inspection report for all fire doors (missing resident room doors) |
| Fire doors found throughout with excessive gaps |
| Claire bridge studio kitchen door found damaged |
| Signage shall be installed/updated in accordance with locking arrangement |
Report Facts
Next inspection scheduled date: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sean Guerrero | Executive Director | Signed as Owner or Authorized Representative on inspection report |
| Nicholas Wolden | Deputy State Fire Marshal | Signed as Deputy State Fire Marshal on inspection report |
| Nick Fletcher | Signed as Owner or Authorized Representative on follow-up inspection report dated 3/28/2025 |
Inspection Report
Complaint Investigation
Census: 68
Deficiencies: 1
Sep 9, 2024
Visit Reason
The inspection was an unannounced on-site complaint investigation conducted due to allegations of quality of care/treatment related to a resident to resident altercation.
Findings
The investigation found that the facility failed to report suspected abuse to the Washington State Department of Social and Health Services within the required timeframe, specifically failing to report for 13 to 20 days. This failure was identified as a failed provider practice and citations were written.
Complaint Details
The complaint involved quality of care/treatment concerning a resident to resident altercation. The facility investigated but failed to notify the state of the incident for 13 to 20 days, which was determined to be a failed provider practice with citations issued.
Deficiencies (1)
| Description |
|---|
| Facility failed to report suspected abuse to the state for 3 of 3 sampled residents within the required timeframe, preventing proper investigation and evaluation of protective systems. |
Report Facts
Total residents: 68
Resident sample size: 4
Closed records sample size: 1
Days delayed in reporting: 13
Days delayed in reporting: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Burdick | AFH Nurse Field Manager | Investigator and Field Manager involved in the complaint investigation |
| Richard Westom | NCI, ALF Complaint Investigator | Complaint Investigator who conducted on-site verification |
Inspection Report
Complaint Investigation
Census: 74
Deficiencies: 1
Dec 19, 2023
Visit Reason
The visit was an unannounced on-site complaint investigation conducted due to allegations that a resident was given a hot beverage without proper monitoring, resulting in the resident spilling the beverage and sustaining a skin burn.
Findings
The investigation substantiated that the facility failed to provide adequate monitoring and preventative measures related to hot beverage service, resulting in a resident sustaining a skin burn. The facility was cited for failing provider practice related to this issue.
Complaint Details
The complaint was substantiated based on interviews, observations, and record reviews that confirmed the resident was given a hot beverage that spilled causing a skin burn.
Deficiencies (1)
| Description |
|---|
| Failure to provide for the safety and well-being of a resident related to hot beverage service, resulting in a burn injury. |
Report Facts
Total residents: 74
Resident sample size: 4
Complaint number: 109890
Hot water dispenser temperature: 164
Recommended hot liquid serving temperature: 155
Corrective action temperature range: 140
Corrective action temperature range: 145
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Yvonne Chitekwe | Investigator | Department staff who conducted the investigation and on-site verification |
| Sean Guerrero | Executive Director II | Signed the plan of correction letter |
| Michael Burdick | Field Manager | Signed the follow-up inspection letter |
Inspection Report
Complaint Investigation
Census: 74
Deficiencies: 1
Dec 19, 2023
Visit Reason
The inspection was conducted as an unannounced complaint investigation regarding allegations that a resident was given a hot beverage without proper monitoring, resulting in the resident spilling the hot liquid and sustaining a burn.
Findings
The investigation substantiated that the facility failed to provide adequate monitoring when a resident was given a hot beverage, which spilled and caused a skin burn. The facility did not implement preventative measures as required by the resident's service plan, and staff were not trained to cool hot liquids prior to serving.
Complaint Details
The complaint was substantiated based on interviews, observations, and record reviews. The resident was given hot chocolate that spilled on their right inner thigh causing a burn. Staff admitted failure to cool the hot liquid and to monitor the resident properly.
Deficiencies (1)
| Description |
|---|
| Facility failed to provide for the safety and well-being of a resident by not implementing preventative measures during hot beverage service, resulting in a burn. |
Report Facts
Total residents: 74
Resident sample size: 4
Hot water dispenser temperature: 164
Recommended hot liquid temperature range: 135
Recommended hot liquid temperature range: 140
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Yvonne Chitekwe | Investigator | Conducted the complaint investigation and on-site verification |
| Michael Burdick | Field Manager | Signed follow-up inspection letter |
| Staff B | Dining Service Manager | Reported unsafe hot water dispenser temperature and lack of caregiver training |
| Staff C | Caregiver | Gave hot chocolate to resident and failed to cool liquid or monitor resident |
| Staff D | Caregiver | Reported observations of Staff C's actions during hot beverage service |
| Staff A | Executive Director | Stated that Staff C did not check hot water temperature or place lid on cup |
Inspection Report
Follow-Up
Census: 69
Capacity: 70
Deficiencies: 9
Oct 13, 2023
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, indicating the facility meets Assisted Living Facility licensing requirements. Previous deficiencies related to nursing delegation and other licensing laws were corrected.
Deficiencies (9)
| Description |
|---|
| Failure to ensure a registered nurse delegated nursing tasks properly and supervised medication technicians administering insulin injections. |
| Failure to ensure staff had current Washington State background checks within required timeframes. |
| Failure to ensure staff completed national fingerprint background checks. |
| Failure to ensure staff had current first aid and CPR training certifications. |
| Failure to complete tuberculosis testing within required timeframe for new staff. |
| Failure to ensure negotiated service agreements were signed annually by responsible parties for some residents. |
| Failure to ensure Medicaid policy was signed and kept in resident records for some residents. |
| Failure to complete full assessments within 14 days of resident move-in for some residents. |
| Failure to provide medication administration documentation and supervision for delegated nursing tasks. |
Report Facts
Residents present during inspection: 69
Total licensed capacity: 70
Sample size for review: 9
Deficiency completion dates: Completion dates for compliance determinations 31065 (10/13/2023) and 27805 (08/16/2023)
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Siharath | ALF Licensor | Department staff who conducted off-site verification and inspections |
| Kyle Gehlen | ALF Licensor - LTC | Department staff who conducted off-site verification and inspections |
| Michael Burdick | Field Manager | Signed letters related to inspection and compliance determinations |
Inspection Report
Plan of Correction
Deficiencies: 0
Oct 13, 2023
Visit Reason
This document is the result of an Informal Dispute Resolution (IDR) process regarding disputed deficiencies identified in a Statement of Deficiencies (SOD) report dated August 16, 2023, for the Assisted Living Facility Brookdale Vancouver Stonebridge.
Findings
After review of all materials, oral statements, and records, the decision was made not to change the original SOD report dated August 16, 2023. The facility is instructed to begin correcting the disputed deficiencies immediately and submit a Plan/Attestation Statement within 10 calendar days.
Report Facts
Correction timeframe: 45
Plan/Attestation Statement submission timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rebecca Fueston | IDR Program Manager | Author of the IDR results letter |
| Michael Burdick | Field Manager | Contact for mailing Plan/Attestation Statement |
| Matt Hauser | Compliance Specialist | Copied on the letter |
Notice
Deficiencies: 0
Sep 19, 2023
Visit Reason
The letter confirms the scheduling of an Informal Dispute Resolution (IDR) meeting requested by the facility administrator to dispute a Statement of Deficiencies dated August 16, 2023, and a Civil Fine dated August 28, 2023.
Findings
The document does not contain inspection findings but relates to the dispute process for cited deficiencies and civil fines.
Report Facts
Civil Fine Date: Aug 28, 2023
Statement of Deficiencies Date: Aug 16, 2023
IDR Meeting Date: Oct 5, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sean Guerrero | Administrator | Facility representative participating in the IDR process |
| Cori Sandquist | RN | Facility representative participating in the IDR process |
| Deanne Moore | RN | Facility representative participating in the IDR process |
Inspection Report
Follow-Up
Deficiencies: 1
Aug 16, 2023
Visit Reason
The Department of Social and Health Services conducted a follow-up visit to Brookdale Vancouver Stonebridge to verify correction of previously cited deficiencies related to nursing task delegation and supervision.
Findings
The facility failed to ensure that a registered nurse delegated nursing tasks properly when five medication technicians administered insulin injections without proper delegation, supervision, or evaluation. This deficiency was uncorrected from a prior citation on June 12, 2023, resulting in a civil fine.
Deficiencies (1)
| Description |
|---|
| Failure to ensure a registered nurse delegated nursing tasks as required when five medication technicians administered insulin injections without proper delegation, supervision, and evaluation. |
Report Facts
Civil fine amount: 300
Number of medication technicians: 5
Inspection Report
Re-Inspection
Deficiencies: 1
Feb 9, 2023
Visit Reason
The Office of the State Fire Marshal conducted a re-inspection at the facility to verify correction of previous violations.
Findings
The facility was found to have violations related to sprinkler system testing and maintenance, specifically the failure to provide forward flow sprinkler testing as required.
Deficiencies (1)
| Description |
|---|
| Facility shall provide forward flow sprinkler testing |
Report Facts
Next inspection scheduled date: Scheduled on or after 2023-03-11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicholas Wolden | Deputy State Fire Marshal | Signed the re-inspection report |
| Nick Fletcher | Maintenance Manager | Owner or Authorized Representative signing the report |
Inspection Report
Follow-Up
Census: 71
Capacity: 78
Deficiencies: 1
Dec 22, 2022
Visit Reason
The Department completed a follow-up inspection of the Assisted Living Facility to verify correction of previously cited deficiencies related to infection control and licensing compliance.
Findings
The follow-up inspection on 12/22/2022 found no deficiencies and confirmed that the facility met Assisted Living Facility licensing requirements. Previous deficiencies related to infection control, specifically failure to fit test staff for N-95 respirators, were corrected.
Complaint Details
Complaint investigation conducted from 04/21/2022 through 05/04/2022 regarding a disease outbreak of Covid-19 in the facility. The investigation found the facility did not follow appropriate infection control practices by not fit testing all caregivers for N-95 respirators working with Covid-19 residents. Failed Provider Practice was identified and citations were written.
Deficiencies (1)
| Description |
|---|
| Facility failed to implement current infection control guidelines by ensuring staff were fit tested for N-95 respirators when working with Covid-19 positive residents, placing residents at risk of infection during an outbreak. |
Report Facts
Total residents: 63
Resident sample size: 0
Current residents: 71
Current residents: 78
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason Rose | Investigator | Conducted complaint investigation and follow-up inspections |
| Jody Just | Field Manager | Signed enforcement and follow-up letters |
| Michael Burdick | Field Manager | Signed enforcement letters |
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