Inspection Reports for Evergreen Court
900 124TH AVENUE NE, BELLEVUE, WA, 98005
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
16 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
154% worse than Washington average
Washington average: 6.3 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
37 residents
Based on a August 2025 inspection.
Census over time
Inspection Report
Follow-Up
Census: 37
Deficiencies: 0
Date: Aug 11, 2025
Visit Reason
The Department completed a follow-up inspection of the Assisted Living Facility on 08/11/2025 to verify correction of previously cited deficiencies.
Findings
The follow-up inspection found no deficiencies and confirmed that previously cited deficiencies related to ongoing assessments and signing negotiated service agreements were corrected.
Report Facts
Residents present during follow-up: 37
Residents sampled: 11
Total residents: 36
Residents sampled: 7
Former residents sampled: 0
Staff screened for tuberculosis: 3
Staff required to be screened for tuberculosis: 6
Pets with expired vaccinations: 1
Pets residing in facility: 3
Staff failed to complete background check within one day: 1
Staff required to complete background check: 6
Residents at risk due to unapproved occupancy: 3
Residents at risk due to ventilation failure: 37
Residents at risk due to lack of personal protective equipment: 40
Staff failed to have PPE: 6
Residents affected by respiratory illness: 22
Staff affected by respiratory illness: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Anderson | Community Field Manager | Signed follow-up inspection letter and plan of correction correspondence |
| Claudia Allis | ALF Licensor | Department staff who conducted inspections and investigations |
| Steven Garrett | LTC Licensor | Department staff who conducted inspections and investigations |
| Staff A | Executive Director | Named in findings related to infection control, medication administration, and staff screening |
| Staff G | Wellness Nurse | Named in findings related to infection control and resident monitoring |
| Staff C | Caregiver | Named in findings related to infection control and staff screening |
Inspection Report
Follow-Up
Census: 37
Deficiencies: 5
Date: Apr 23, 2025
Visit Reason
The Department of Social and Health Services completed a follow-up visit to Evergreen Court to assess correction of previously cited deficiencies.
Findings
The facility was found to have multiple uncorrected deficiencies related to resident assessments, service plan agreements, licensed bed capacity approval, and maintenance issues such as ventilation. Civil fines totaling $1,500 were imposed based on these ongoing violations.
Deficiencies (5)
Failed to complete one resident’s assessments including required full assessment components.
Failed to ensure one resident or their representative and a facility representative signed their Service Plan Report annually.
Failed to notify and receive approval for the addition of three rooms and occupancy to licensed bed count.
Failed to provide ventilation fans in four rooms to ensure proper air flow and ventilation.
Failed to document in one resident’s service agreements a plan to monitor and address interventions required to meet current needs.
Report Facts
Civil fine amount: 300
Civil fine amount: 200
Civil fine amount: 400
Civil fine amount: 300
Civil fine amount: 300
Total civil fines: 1500
Resident census: 37
Number of rooms added without approval: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Matt Hauser | Compliance Specialist | Signed the enforcement letter regarding civil fines |
| Laurie Anderson | Field Manager | Contact person for plan of correction and inquiries |
Inspection Report
Life Safety
Deficiencies: 13
Date: Jul 29, 2024
Visit Reason
The Office of the State Fire Marshal conducted a fire safety inspection at Evergreen Court, a residential care facility, to evaluate compliance with fire protection and life safety codes.
Findings
The inspection identified multiple deficiencies including missing documentation for fire drills, incomplete cleaning and maintenance records for fire safety equipment, combustible materials improperly stored in various areas, malfunctioning exit signs and emergency lighting, and issues with fire door operation and inspection schedules. Several violations were corrected on site, while others require follow-up and documentation.
Deficiencies (13)
Facility cannot provide documentation for the completion of twelve planned and unannounced fire drills in the previous 12 months; drills missing for all shifts and quarters.
Combustible materials found on the 3rd floor stairwell.
Combustible materials found in electrical room bottom floor.
Open junction found on 3rd floor in electrical room outside of meeting room/restroom.
First and second semi-annual hood cleaning not provided.
Facility needs to establish a schedule for inspection of Fire-Rated construction; annual inspection required.
Room 163 and PPE door will not latch properly.
Annual and periodic testing and maintenance documentation for sprinkler systems, fire extinguishing systems, fire alarm systems, carbon monoxide detection, emergency lighting, and fire/smoke dampers not provided or incomplete.
Exit sign not working when test button is performed on main floor by room 95.
Emergency lighting not working by room 221, room 227, and throughout stairwells.
30-second monthly activation test and annual 90-minute power test for emergency lighting not performed or documented.
Fire/smoke damper inspection not performed or documented.
Fire doors inspection and testing documentation missing; several operational and maintenance issues noted including latching hardware, auxiliary hardware, signage, gasketing, and self-closing devices.
Report Facts
Missing fire drills: 12
Inspection date: Jul 29, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jason Van Gorkum | Deputy State Fire Marshal | Signed the inspection report as the inspecting official. |
Inspection Report
Life Safety
Deficiencies: 17
Date: May 23, 2024
Visit Reason
The Office of the State Fire Marshal conducted a fire safety inspection at Evergreen Court, a residential care facility, to assess compliance with fire protection and safety codes.
Findings
The inspection found multiple deficiencies including combustible materials stored improperly, missing documentation for fire drills and system maintenance, open electrical junctions, malfunctioning exit signs and emergency lighting, and issues with fire door operations. Several required tests and inspections for fire safety systems were not documented or performed.
Deficiencies (17)
1st floor storage room (PPE) is within 18" of sprinkler head
Combustible materials found on the 3rd floor stairwell
Combustible materials found in electrical room bottom floor
Facility cannot provide documentation for the completion of twelve planned and unannounced fire drills in the previous 12 months
Open junction found on 3rd floor in electrical room outside of meeting room/restroom
First and second semi-annual hood cleaning documentation not provided
Facility needs to identify and establish a schedule for inspection of Fire-Rated construction; annual inspection required
Room 163 and PPE door will not latch properly
Annual and periodic testing and maintenance documentation for sprinkler, extinguishing, and fire alarm systems not provided
Carbon Monoxide Alarms and Detectors need monthly testing, maintenance, and documentation
Exit sign not working when test button is performed on main floor by room 95
Emergency lights not working by room 221, room 227, and in stairwells
30-second monthly activation testing of emergency lighting not performed and documented
Annual 90 minute power test of emergency lighting not performed and documented
Fire/smoke damper inspection not performed and documented
Facility needs to identify and establish a schedule for inspection of Fire Doors; annual inspection required
Latching hardware does not secure door; auxiliary hardware interferes with door operation; signage affixed to door does not meet requirements
Report Facts
Number of planned and unannounced fire drills missing documentation: 12
Next inspection scheduled date: Jun 24, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jason Van Gorkum | Deputy State Fire Marshal | Conducted the inspection and signed the report |
Inspection Report
Life Safety
Deficiencies: 13
Date: Jul 6, 2023
Visit Reason
The Office of the State Fire Marshal conducted a fire safety inspection at the Evergreen Court residential care facility on 7/6/2023 to verify correction of previous violations.
Findings
All violations noted during previous related inspections have been corrected as of the 7/6/2023 inspection. The prior inspection on 5/25/2023 cited multiple fire safety deficiencies including power supply issues, extension cord misuse, missing covers, cleaning needs, missing inspection paperwork, and fire extinguisher placement problems.
Deficiencies (13)
Daisy Chain power strip found in activities room and break room
Extension cord being used near bathrooms in lobby
Missing cover by resident room 143 and missing cover under steam table in dining room
Hood was in need of cleaning; cleaning schedule may need to be evaluated for more frequent cleaning
Annual inspection of fire-resistance-rated construction paperwork not provided
2nd floor stairwell door by 135, double doors going into dining room, and kitchen door issues
First and second semi-annual servicing and annual replacement of fusible links/auto sprinkler heads paperwork not provided
Monthly inspection by Facility Maintenance Log not provided
Fire extinguisher found on floor under reception desk and in activities office
30-second monthly activation test and annual 90 minute power test paperwork not provided; exit sign not working on 2nd floor by resident room 143
Fire/smoke damper 4-year inspection paperwork not provided
Fire door annual inspection paperwork not provided
Fire drill report with participants listed not provided
Report Facts
Inspection date: May 25, 2023
Next inspection scheduled on or after: Jun 28, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tym Swain | Maintenance Director | Owner or Owner's Representative signing the inspection report |
| Jason Van Gorkum | Deputy State Fire Marshal | Official conducting the inspection and signing the report |
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