Inspection Reports for Merrill Gardens at Burien
15020 5th Ave SW, Burien, WA 98166, WA, 98166
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Inspection Report
Life Safety
Deficiencies: 3
Feb 26, 2025
Visit Reason
The Office of the State Fire Marshal conducted an inspection at the facility to assess compliance with fire safety and fire-resistance-rated construction requirements.
Findings
The facility was found to have failed to provide documentation showing annual inspection of fire-resistance-rated construction and failed to provide required documentation for the automatic sprinkler system, including the three-year dry system full flow trip test and the five-year fire department connection hydrostatic test.
Deficiencies (3)
| Description |
|---|
| Facility failed to provide documentation showing annual inspection of fire-resistance-rated construction. |
| Facility failed to provide documentation for the automatic sprinkler system's three-year dry system full flow trip test. |
| Facility failed to provide documentation for the automatic sprinkler system's five-year fire department connection hydrostatic test. |
Report Facts
Next inspection scheduled date: Next inspection scheduled on or after 04/03/2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Filipovic | Maintenance Director | Named as Owner or Authorized Representative signing the inspection documents |
| Raul Murcia | Deputy State Fire Marshal | Conducted the inspection and signed the report |
Inspection Report
Follow-Up
Capacity: 43
Deficiencies: 0
Jul 9, 2024
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 Assisted Living Facility licensing requirements. Previously cited deficiencies related to tuberculosis testing were corrected.
Report Facts
Residents sampled for follow-up: 0
Deficiencies cited: 4
Days late for background check: 2266
Days late for background check: 506
Days late for background check: 2098
Days late for background check: 285
Days late for background check: 879
Days late for background check: 77
Days late for background check: 34
Days late for background check: 43
Days late for background check: 122
Days late for background check: 61
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff N | Caregiver | Failed to complete required two-step tuberculosis skin testing within three days of employment. |
| Staff W | Caregiver | Failed to complete required tuberculosis test within three days of hire despite history of negative QuantiFERON test. |
| Staff C | Caregiver | Failed to complete tuberculosis test within three days of employment. |
| Staff U | Receptionist | Failed to complete tuberculosis test within three days of employment. |
| Staff V | Caregiver | No tuberculosis test completed six days after employment. |
| Staff E | Caregiver | Failed to complete required continuing education hours and nurse delegation training. |
| Staff G | Caregiver | Failed to complete required continuing education hours and nurse delegation training. |
| Staff H | Caregiver | Failed to complete required continuing education hours. |
| Staff L | Registered Nurse Delegator | Failed to submit background check within one day of hire; failed to obtain resident consents for nurse delegation; failed to verify credentials and training of delegated staff. |
| Staff M | Agency Caregiver | Failed to submit background check through DSHS Background Check Central Unit. |
| Staff A | Caregiver, Medication Technician | Failed to complete nurse delegation core certification training; delegated medication administration without resident consent. |
| Staff O | Medication Technician | Failed to complete basic caregiver training and nurse delegation core certification training; delegated medication administration without resident consent. |
| Staff P | Medication Technician | Delegated medication administration without nurse delegation training and supervision. |
| Staff Q | Medication Technician | Delegated medication administration without nurse delegation training and supervision. |
| Staff J | Business Office Manager | Interviewed regarding tuberculosis testing and background check deficiencies. |
| Staff I | Administrator/Resident Care Director | Interviewed regarding nurse delegation and resident consents. |
| Laurie Anderson | Field Manager | Signed enforcement letter and correspondence. |
| Thomas Forkgen | ALF Licensor | Conducted on-site verification and inspections. |
| Michelle Yip | ALF Licensor | Conducted on-site verification and inspections. |
Inspection Report
Follow-Up
Deficiencies: 2
May 16, 2024
Visit Reason
The Department of Social and Health Services completed a follow-up visit to Merrill Gardens at Burien to assess correction of previously cited deficiencies related to tuberculosis testing of staff.
Findings
The facility failed to test one staff member for tuberculosis using the two-step skin test and failed to complete a tuberculosis test for another staff member with a history of a negative QuantiFERON test. These deficiencies were uncorrected from a prior citation dated March 14, 2024, resulting in civil fines.
Deficiencies (2)
| Description |
|---|
| Failure to test one staff for tuberculosis using two-step skin testing. |
| Failure to complete a tuberculosis test for one staff with a history of a negative QuantiFERON test. |
Report Facts
Civil fine amount: 200
Civil fine amount: 200
Total civil fines: 400
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Matt Hauser | Compliance Specialist | Signed the letter regarding civil fines and inspection findings. |
| Laurie Anderson | Field Manager | Contact person for submission of Plan of Correction and inquiries. |
Inspection Report
Life Safety
Deficiencies: 7
Mar 12, 2024
Visit Reason
An unannounced Fire and Life Safety Code inspection was conducted at Merrill Gardens at Burien by the Washington State Patrol, State Fire Marshal's Office to determine compliance with applicable codes.
Findings
Multiple fire and life safety code violations were observed including improper use of power tap cords, fire door defects, failure of fire doors to close properly, missing fire door inspection documentation, loaded fire sprinklers, improperly mounted fire extinguisher, and emergency lights not working properly.
Deficiencies (7)
| Description |
|---|
| The kitchen has a power strip dangling by the storage room. |
| The Spa Service fire door has a penetration in it from switching door handles. |
| The facility was unable to provide documentation for inspection of all fire doors. |
| The following doors did not close/latch properly: Outside Storage room by garage gate, Laundry door inside laundry room, Cross corridor 2C by 228. |
| Loaded fire sprinklers observed in kitchen by back storage and dining room by kitchen by vent; missing escutcheon ring outside of Activities. |
| Fire extinguisher in outside storage paint room not properly mounted. |
| Emergency lights did not work properly when tested at stairway exit A going out to garage, stairway C between 2 and 3, and hallway by resident room 332. |
Report Facts
Next inspection scheduled: Apr 11, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Filipovic | Maintenance Director | Owner or Authorized Representative signing inspection documents |
| Cozetta Christian | Deputy State Fire Marshal | Conducted the inspection and signed the report |
Inspection Report
Life Safety
Deficiencies: 12
Feb 15, 2023
Visit Reason
The Office of the State Fire Marshal conducted an inspection at the facility to assess compliance with fire safety and life safety codes.
Findings
Multiple violations were observed including open conduits needing resealing, fire doors not closing properly, missing escutcheon rings, deficient sprinkler system components, missing carbon monoxide alarms, lack of documentation for CO detector testing and emergency lighting tests, unsecured oxygen bottles, and blocked fire extinguishers.
Deficiencies (12)
| Description |
|---|
| Open conduits needing resealing in Resident Storage by room 410 and Main Electrical room - Basement |
| Fire doors did not close/latch properly in Cross Corridor 2C - 2nd floor and Cross corridor MC 2 - Memory Care |
| Storage room in Community room missing an escutcheon ring and sprinkler head with glue on ceiling |
| Annual sprinkler report marked deficient due to painted sprinkler head and failed 3 year trip test |
| Elevator #2 mechanical room has a fire extinguisher out of the green zone - 4th floor |
| Activities room door was propped open blocking the fire extinguisher (corrected at time of inspection) |
| No carbon monoxide alarms in commercial laundry room where gas fed appliances are used - 2nd floor |
| Facility unable to provide documentation showing CO detector testing performed in past 12 months |
| Emergency light in hall by room 419 did not operate when tested - 4th floor |
| Facility failed to provide documentation showing 30-second monthly testing of emergency lighting in last 12 months; missing July 2022 - December 2023 |
| Resident room 339 has a bottle of unsecured oxygen in the closet |
| Resident rooms 331, 339, and 221 do not have oxygen signs on the door |
Report Facts
Inspection date: Feb 15, 2023
Provider Number: 2406
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| John N. Nass | Maintenance Director | Named as Owner's Representative and signed inspection documents |
| Cozetta Christian | Deputy State Fire Marshal | Conducted the inspection and signed the report |
Inspection Report
Follow-Up
Census: 48
Deficiencies: 5
Nov 30, 2022
Visit Reason
The Department completed a follow-up inspection of the Assisted Living Facility on 11/30/2022 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 related to service agreement planning, medication services, food sanitation, infection control, and background checks were corrected.
Deficiencies (5)
| Description |
|---|
| Failure to update residents' negotiated service agreements consistent with regulations, placing residents at risk for unmet needs. |
| Failure to follow prescriber's orders for medication administration, placing a resident at risk for hypoglycemia and compromised health. |
| Failure to maintain cold holding food temperatures at or below 41 degrees Fahrenheit, placing all residents at risk for food-borne illness. |
| Failure to implement required respiratory protection program for staff to reduce COVID-19 spread, placing all residents at risk. |
| Failure to complete required background checks for contracted caregiver staff, placing residents at risk for potential abuse and neglect. |
Report Facts
Residents present during inspection: 48
Sample size for review: 7
Staff count: 51
Deficiencies cited: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Yip | ALF Licensor | Department staff who did the on-site verification during follow-up inspection |
| Jane Hermano | NCI | Department staff who did the on-site verification during follow-up inspection |
| Laurie Anderson | Field Manager | Field Manager who signed letters and correspondence related to the inspection |
| Thomas Forkgen | ALF Licensor | Department staff who inspected the Assisted Living Facility during full inspection |
| Kathy Young | Licensor | Department staff who inspected the Assisted Living Facility during full inspection |
| Staff J | Executive Chef | Named in food temperature monitoring deficiency |
| Staff O | Cook | Named in food temperature monitoring deficiency |
| Staff A | Licensed Practical Nurse | Named in smoking policy and medication administration findings |
| Staff H | General Manager | Named in smoking policy finding |
| Staff M | Medication Technician | Named in medication administration deficiency |
| Staff E | Certified Nursing Assistant, Medication Technician/Caregiver | Named in respiratory protection program deficiency |
| Staff B | Certified Nursing Assistant, Caregiver | Named in respiratory protection program deficiency |
| Staff F | Caregiver | Named in smoking policy finding |
| Staff G | Vice President of Operations | Signed letter issuing final notice to Resident 4 regarding smoking |
| CC1 | Contracted Caregiver | Named in background check deficiency |
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