Inspection Reports for Clearwater Springs Assisted Living
201 NW 78th St, Vancouver, WA 98665, United States, WA, 98665
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Inspection Report
Enforcement
Deficiencies: 1
Oct 17, 2025
Visit Reason
The Department of Social and Health Services completed a follow-up visit to Clearwater Springs Assisted Living to address previously cited deficiencies and enforce compliance, resulting in the imposition of a civil fine.
Findings
The licensee failed to provide timely refunds to resident representatives for 13 residents within 30 days after discharge, placing residents at risk for financial exploitation. This was a recurring and uncorrected deficiency previously cited multiple times.
Deficiencies (1)
| Description |
|---|
| Failure to provide a timely refund to a resident representative for 13 residents within 30 days after discharge. |
Report Facts
Civil fine amount: 1200
Number of residents affected: 13
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clinton Fridley | RN, Field Manager | Contact person for plan of correction and follow-up |
| Matt Hauser | Compliance Specialist | Signed the enforcement letter |
Notice
Deficiencies: 0
Oct 6, 2025
Visit Reason
The Department of Social and Health Services issued a Stop Placement Order based on a Statement of Deficiencies dated September 24, 2025.
Findings
A Stop Placement Order was imposed on the license of Clearwater Springs Assisted Living effective October 6, 2025, and remains in effect until formally lifted.
Report Facts
License number: 2579
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Matt Hauser | Compliance Specialist | Signed the Stop Placement Order notice |
Inspection Report
Enforcement
Deficiencies: 1
Sep 24, 2025
Visit Reason
The Department of Social and Health Services conducted a follow-up visit to Clearwater Springs Assisted Living to address ongoing deficiencies, resulting in a stop placement order prohibiting admissions due to failure to comply with fire safety ordinances.
Findings
The facility failed to comply with local and state fire ordinances, placing residents, visitors, and staff at risk of injury or harm in the event of a fire. This deficiency was repeated and uncorrected despite previous citations, leading to the issuance of a stop placement order prohibiting admissions effective October 6, 2025.
Deficiencies (1)
| Description |
|---|
| Failure to stay in compliance with local and state fire ordinances placing all residents, visitors, and staff at risk of injury and harm in the event of a fire. |
Report Facts
Dates of previous citations: Repeated deficiency previously cited on August 1, 2025, July 26, 2024, June 16, 2025, and April 29, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clinton Fridley | Field Manager | Contact person for approval requests and plan of correction submission |
| Matt Hauser | Compliance Specialist | Signed the enforcement letter |
Inspection Report
Follow-Up
Deficiencies: 1
Aug 1, 2025
Visit Reason
The Department of Social and Health Services conducted a follow-up visit to Clearwater Springs Assisted Living to verify correction of previously cited deficiencies.
Findings
The facility failed to comply with local and state fire ordinances, resulting in a recurring deficiency that placed residents, visitors, and staff at risk of injury or harm in the event of a fire. This deficiency was previously cited on June 16, 2025, and April 29, 2025, and remains uncorrected.
Deficiencies (1)
| Description |
|---|
| Failure to stay in compliance with local and state fire ordinances for the assisted living facility. |
Report Facts
Civil fine amount: 2000
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clinton Fridley | RN, Field Manager | Contact person for plan of correction and follow-up |
| Matt Hauser | Compliance Specialist | Signed the imposition of civil fines letter |
Inspection Report
Enforcement
Deficiencies: 1
Jul 8, 2025
Visit Reason
The Department of Social and Health Services completed a follow-up visit to Clearwater Springs Assisted Living to address previously cited deficiencies and to impose a civil fine related to resident rights violations.
Findings
The facility failed to provide timely refunds to resident representatives within 30 days after resident discharge for three residents, resulting in a civil fine of $600. This deficiency was previously cited and remains uncorrected.
Deficiencies (1)
| Description |
|---|
| Failure to provide a timely refund to a resident representative for three residents within 30 days after discharge. |
Report Facts
Civil fine amount: 600
Residents reviewed for refund: 3
Previous citation date: Apr 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clinton Fridley | RN, Field Manager | Contact person for plan of correction and follow-up. |
| Matt Hauser | Compliance Specialist | Signed the enforcement letter. |
Inspection Report
Enforcement
Census: 71
Deficiencies: 1
Jun 16, 2025
Visit Reason
The Department of Social and Health Services conducted a follow-up visit to Clearwater Springs Assisted Living to assess compliance with previous deficiencies and to impose a civil fine for uncorrected violations.
Findings
The facility failed to comply with local and state fire ordinances, placing 71 residents at risk in the event of a fire. This deficiency was uncorrected from a prior inspection on April 29, 2025, resulting in a civil fine of $1,500.
Deficiencies (1)
| Description |
|---|
| Failure to stay in compliance with local and state fire ordinances, placing residents' lives and safety at risk. |
Report Facts
Civil fine amount: 1500
Residents at risk: 71
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clinton Fridley | RN, Field Manager | Contact person for plan of correction and appeals |
| Matt Hauser | Compliance Specialist | Signed the enforcement letter |
Inspection Report
Follow-Up
Census: 77
Deficiencies: 12
Mar 5, 2025
Visit Reason
The Department completed a follow-up inspection of Clearwater Springs Assisted Living Facility on 03/05/2025 to verify correction of previously cited deficiencies.
Findings
The follow-up inspection found no deficiencies and confirmed that the facility meets Assisted Living Facility licensing requirements. Previous deficiencies related to intermittent nursing services and nurse delegation were corrected.
Deficiencies (12)
| Description |
|---|
| Facility failed to ensure a registered nurse had delegated nursing tasks to staff and supervised and evaluated at least every two weeks for the first four weeks of insulin administration to sampled residents, resulting in untrained and unsupervised care staff administering insulin injections placing residents at risk for harm. |
| Facility failed to ensure nurse delegation core training and diabetes specific training was completed by medication technicians and failed to ensure nurse delegation consent and documentation for residents. |
| Facility failed to ensure all staff received required training and orientation including long-term care worker training, specialty training for mental health and dementia, and CPR certification. |
| Facility failed to properly secure chemicals in laundry rooms, posing health and safety risk to residents and staff. |
| Facility failed to ensure negotiated service agreements were signed by responsible parties for sampled residents within a reasonable timeframe. |
| Facility failed to ensure Medicaid policy was signed and maintained for sampled residents. |
| Facility failed to ensure fire extinguishers were inspected monthly and maintained in working order. |
| Facility failed to ensure tuberculosis testing was completed timely for sampled staff. |
| Facility failed to ensure ongoing assessments were completed by qualified assessors for sampled residents. |
| Facility failed to ensure medication carts were locked and accessible only to designated staff, posing risk of adverse reactions. |
| Facility failed to ensure resident rights related to Medicaid policy disclosure and signature were met for sampled residents. |
| Facility failed to ensure combined utility area for laundry services was properly provided with necessary space to maintain infection control and properly store cleaning agents. |
Report Facts
Sampled residents: 77
Sampled residents: 2
Sampled staff: 17
Sampled staff: 5
Sampled residents: 12
Sampled residents: 9
Sampled residents: 8
Sampled staff: 5
Sampled residents: 5
Sampled residents: 4
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 |
| Staff A | Executive Director | Acknowledged department findings and interviewed during inspections |
| Staff B | Health Services Director | Interviewed and discussed preliminary findings; reviewed staff records |
| Staff D | Medication Technician | Reviewed for training and tuberculosis testing documentation |
| Staff E | Medication Technician | Reviewed for training documentation |
| Staff F | Medication Technician | Reviewed for training documentation |
| Staff G | Medication Technician | Reviewed for nurse delegation training and background check |
| Staff H | Medication Technician | Reviewed for nurse delegation training and background check |
| Staff J | Medication Technician | Reviewed for nurse delegation training |
| Staff C | Resident Care Coordinator | Completed ongoing assessments and involved in care planning |
| Staff I | Environmental Services Director | Acknowledged fire marshal requirements and inspection tags |
| Staff P | Medication Technician | Reviewed for tuberculosis testing documentation |
| Staff Q | Caregiver | Reviewed for tuberculosis testing documentation |
| Staff K | Housekeeper | Interviewed regarding laundry services and infection control |
Inspection Report
Enforcement
Deficiencies: 1
Jan 14, 2025
Visit Reason
The Department of Social and Health Services completed a follow-up visit to Clearwater Springs Assisted Living to assess compliance with previously cited deficiencies and imposed a civil fine based on violations found during the visit.
Findings
The facility failed to ensure that a registered nurse delegated nursing tasks and supervised staff administering insulin injections to two residents, resulting in untrained and unsupervised care staff administering insulin injections, placing residents at risk for harm. This deficiency was uncorrected and recurring from previous citations.
Deficiencies (1)
| Description |
|---|
| Failure to ensure a registered nurse delegated nursing tasks and supervised staff administering insulin injections to two residents. |
Report Facts
Civil fine amount: 1000
Previous citation dates: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Burdick | Field Manager | Contact person for submission of Plan of Correction and inquiries. |
| Matt Hauser | Compliance Specialist | Signed the enforcement letter. |
Inspection Report
Enforcement
Deficiencies: 1
Nov 20, 2024
Visit Reason
The Department of Social and Health Services completed a follow-up visit to Clearwater Springs Assisted Living to assess compliance and impose a civil fine based on violations found during the inspection.
Findings
The facility failed to ensure that a registered nurse delegated required nursing tasks and supervised staff administering insulin injections to two residents, resulting in an uncorrected and recurring deficiency that placed residents at risk of harm.
Deficiencies (1)
| Description |
|---|
| Failure to ensure a registered nurse delegated required nursing tasks and supervised staff administering insulin injections to two residents. |
Report Facts
Civil fine amount: 600
Previous citation dates: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Matt Hauser | Compliance Specialist | Signed the enforcement letter. |
| Michael Burdick | Field Manager | Contact person for plan of correction and inquiries. |
Inspection Report
Follow-Up
Census: 85
Deficiencies: 6
Sep 19, 2024
Visit Reason
The Department of Social and Health Services conducted a follow-up visit to Clearwater Springs Assisted Living to assess correction of previously cited deficiencies.
Findings
Multiple uncorrected deficiencies were found, including failures in nursing supervision of insulin administration, staff training documentation, signing of negotiated service agreements, tuberculosis testing, securing chemicals, and fire extinguisher inspections. Civil fines totaling $1,200 were imposed based on these violations.
Deficiencies (6)
| Description |
|---|
| Failure to ensure a registered nurse delegated nursing tasks and supervised staff administering insulin injections to one resident at least every two weeks for the first four weeks. |
| Failure to ensure five staff had completed and/or had documentation of required training to work as long-term care workers. |
| Failure to ensure the Negotiated Service Agreement was agreed to and signed by the responsible party at least annually and/or within a reasonable timeframe for five residents. |
| Failure to complete the first step of tuberculosis testing within three days of hire for three staff. |
| Failure to properly secure chemicals for carpet cleaning in one laundry room accessed by residents. |
| Failure to ensure one fire extinguisher had been inspected monthly to verify proper operation. |
Report Facts
Civil fines total: 1200
Residents at risk: 85
Staff without required training: 5
Residents without signed negotiated service agreement: 5
Staff without timely tuberculosis testing: 3
Fire extinguishers not inspected monthly: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Burdick | Field Manager | Contact person for submission of Plan of Correction and inquiries. |
| Matt Hauser | Compliance Specialist | Signed the letter imposing civil fines. |
Inspection Report
Complaint Investigation
Census: 73
Deficiencies: 1
Feb 16, 2024
Visit Reason
The inspection was conducted as an unannounced on-site complaint investigation triggered by allegations regarding a resident's death and failure to provide facility intervention.
Findings
The investigation found failed provider practices including failure to provide cardiopulmonary resuscitation (CPR) to a resident who passed away, violating facility policies and procedures. Citations were issued for these deficiencies.
Complaint Details
The complaint involved allegations of a resident's death with no facility intervention and failure to follow policy and procedures for cardiopulmonary resuscitation. The complaint was substantiated with failed provider practices identified and citations written.
Deficiencies (1)
| Description |
|---|
| Facility staff failed to provide cardiopulmonary resuscitation (CPR) to 1 of 3 residents reviewed during a medical emergency, placing the resident at risk of harm. |
Report Facts
Total residents: 73
Resident sample size: 3
Closed records sample size: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Westom | NCI, ALF Complaint Investigator | Investigator who conducted the complaint investigation |
| Bret League | Administrator | Named in interviews related to CPR policy and plan of correction |
Inspection Report
Re-Inspection
Deficiencies: 7
Dec 28, 2022
Visit Reason
The Office of the State Fire Marshal conducted a re-inspection at the facility to verify correction of previously identified fire safety violations.
Findings
The facility was found to have multiple unresolved fire safety violations including failure to provide smoke detector sensitivity testing, failure to provide a 5-year fire department connection hydro test, failure to provide a 4-year fire damper inspection report, failure to repair fire sprinkler system deficiencies, and failure to conduct required fire drills.
Deficiencies (7)
| Description |
|---|
| Facility failed to provide sensitivity testing of the fire alarm system |
| Facility failed to provide 5 year FDC hydro test |
| Med room door that was replaced failed to have fire rating in compliance with NFPA 80. Door frame listed for 1 1/2 hour |
| Facility failed to provide 4 year fire damper inspection report |
| Facility failed to conduct repairs of the fire sprinkler system deficiencies listed in the annual fire sprinkler report |
| Storage in room 210 found to be blocking exiting |
| Facility failed to conduct fire drills as required; missing shifts in all four quarters |
Report Facts
Next inspection scheduled date: Jan 27, 2023
Next inspection scheduled date: Dec 22, 2022
Fire drills required: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicholas Walden | Deputy State Fire Marshal | Signed as Deputy State Fire Marshal on the inspection report |
Inspection Report
Complaint Investigation
Census: 80
Deficiencies: 1
Dec 9, 2022
Visit Reason
The inspection was conducted as a complaint investigation based on complaints numbered 57231 and 57502, including allegations of fraud/false billing and failure to notify the case manager of resident hospitalization in a timely manner.
Findings
The investigation found no failed practice regarding fraud/false billing, with the family credited for services not received. However, the facility failed to notify the case manager of hospitalization in a timely manner, which was identified as a failed practice with citation(s) written.
Complaint Details
Complaint investigation included allegations of fraud/false billing and failure to notify case manager of hospitalization. The notification failure was substantiated as a failed practice; fraud/false billing was not substantiated.
Deficiencies (1)
| Description |
|---|
| Facility failed to notify case manager of resident hospitalization in a timely manner. |
Report Facts
Total residents: 80
Resident sample size: 3
Closed records sample size: 0
Days late notification: 51
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Westom | ALF Complaint Investigator | Investigator who conducted the complaint investigation |
| Cory Cisneros | Field Manager | Field Manager who signed the follow-up letter |
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