Inspection Report
Life Safety
Deficiencies: 10
Apr 9, 2025
Visit Reason
The Office of the State Fire Marshal conducted a fire protection inspection at Silverado Bellevue, a residential care facility, to verify compliance with fire safety codes and regulations.
Findings
The inspection identified multiple deficiencies related to fire safety, including combustible materials stored too close to sprinkler heads, missing semi-annual hood cleaning documentation, failure to provide detailed fire-rated construction documentation, malfunctioning door latches, and missing required inspection paperwork for various fire safety systems.
Deficiencies (10)
| Description |
|---|
| Combustible materials found within 18 inches of sprinkler head in storage room by room 205 |
| Missing documentation for first and second semi-annual hood cleaning |
| Facility failed to maintain detailed documentation and maps of fire-rated construction locations including annual inspection reports |
| Double doors by room 220 will not latch |
| Missing annual report, 5-year internal pipe testing, 3-year dry system full flow trip test, annual trip test, annual forward flow test, and 5-year FDC hydro testing documentation for sprinkler system |
| Missing second semi-annual service documentation for fire extinguishing system |
| Missing documentation to verify fire alarm monitoring carbon monoxide detection in corridors |
| Missing diesel fuel testing documentation for emergency and standby power systems |
| Missing fire/smoke damper inspection documentation |
| Missing detailed documentation and maps of fire door locations including annual inspection reports |
Report Facts
Provider Number: 2573
Next inspection scheduled on or after: May 8, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason Van Gorkum | Deputy State Fire Marshal | Conducted the inspection and signed the report |
| Kristina Mills | Administrator | Owner or Authorized Representative who signed the report |
Inspection Report
Follow-Up
Deficiencies: 0
Jul 10, 2024
Visit Reason
The Department completed a follow-up inspection of the Assisted Living Facility on 07/10/2024 to verify correction of previously cited deficiencies.
Findings
The follow-up inspection found no deficiencies, and the facility meets the Assisted Living Facility licensing requirements. The Department confirmed that all previously cited deficiencies were corrected.
Report Facts
Compliance Determination Completion Dates: Compliance Determinations #43936 completed on 07/10/2024 and #40715 completed on 05/16/2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thomas Forkgen | ALF Licensor | Department staff who did the on-site verification |
| Steven Garrett | LTC Licensor | Department staff who did the on-site verification |
| Laurie Anderson | Field Manager | Signed the follow-up inspection letter |
Inspection Report
Life Safety
Deficiencies: 12
Apr 3, 2024
Visit Reason
The Office of the State Fire Marshal conducted an inspection at the Silverado Bellevue residential care facility to assess compliance with fire safety and protection codes.
Findings
The inspection identified multiple deficiencies including combustible materials stored improperly, power strips connected unsafely, missing semi-annual hood cleaning paperwork, fire doors held open with wedges, obstructed sprinkler locations, missing annual forward flow test documentation, incomplete semi-annual fire-extinguishing system servicing paperwork, and combustible materials mixed with oxygen tanks.
Deficiencies (12)
| Description |
|---|
| 2nd floor boiler room had storage of combustible material |
| 2nd floor wellness center had a power strip plug into another power strip |
| First semi-annual hood cleaning paperwork was not provided |
| Facility will need to identify and establish a schedule for inspection of Fire-Rated construction |
| 2nd floor boiler room door was being held open with a wedge |
| 2nd floor laundry door was being held open with a wedge |
| 2nd floor laundry door will not latch |
| 1st floor fire door leading to the lobby will not latch |
| 1st floor sitting area has a light fixture with the code distance to the sprinkler head |
| Annual forward flow test paperwork was not provided |
| First and second semi-annual servicing paperwork for fire-extinguishing system was not provided |
| 2nd floor had combustible material mixed with the O2 tanks in room |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Gutierrez | Deputy State Fire Marshal | Signed as the inspector conducting the fire protection inspection |
| Jason Van Gorkum | Deputy State Fire Marshal | Signed as the inspector conducting the fire protection inspection |
Inspection Report
Life Safety
Deficiencies: 9
Mar 23, 2023
Visit Reason
An unannounced Fire and Life Safety Code inspection was conducted at Silverado Bellevue by a representative of the Washington State Patrol, State Fire Marshal's Office to determine compliance with all applicable codes.
Findings
Multiple violations were cited including improper use of power strips, extension cords in unauthorized locations, lack of records for annual fire wall inspections and repairs, penetrations in walls and conduits, missing inventory and maintenance records for fire-resistant-rated assemblies, missing documentation for fire/smoke damper testing, missing carbon monoxide detector testing records, and improper storage and signage for medical gases.
Deficiencies (9)
| Description |
|---|
| The Business Manager's office has a power strip plugged into another power strip. |
| Extension cords were found in use at the outside lights on the 2nd floor and in the laundry room. |
| Facility was unable to provide record of their annual fire wall inspection and/or repairs for all fire-resistant-rated construction. |
| Penetrations in walls/conduits found in IT room around pipes on 2nd floor and sprinkler riser room. |
| Facility was unable to provide inventory record of annual inspection and/or repairs for all fire-resistant-rated doors. |
| Facility was unable to provide documentation for their last fire/smoke damper testing. |
| Facility was unable to provide documentation showing that testing of their CO detectors has been performed in the past 12 months. |
| Storage room on the first floor has combustibles stored with medical gas - By room 119. |
| Rooms storing medical gas will need signage. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose M. Gutierrez | D.P.O. | Signed as the Deputy State Fire Marshal conducting the inspection. |
| Cozetta Christian | Deputy State Fire Marshal | Signed as the Deputy State Fire Marshal conducting the inspection. |
Inspection Report
Follow-Up
Census: 23
Deficiencies: 5
Jan 18, 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 and confirmed that the facility meets Assisted Living Facility licensing requirements. Previous deficiencies related to infection control, background checks, and tuberculosis testing were corrected.
Deficiencies (5)
| Description |
|---|
| Failure to ensure 10 of 33 staff completed respirator fit testing and used fit-tested respirators, placing residents at risk of spreading COVID-19. |
| Failure to submit Washington state name and date of birth background check for 1 of 6 staff prior to unsupervised contact with residents. |
| Failure to submit national fingerprint background check for 1 of 6 staff prior to unsupervised contact with residents. |
| Failure to ensure 2 of 6 staff were screened for tuberculosis within three days of hire. |
| Failure to ensure 1 of 6 staff completed the second step of two-step tuberculosis skin testing within 1 to 3 weeks after the first test. |
Report Facts
Residents sampled: 7
Total residents: 23
Total employees: 33
Days worked unsupervised without background check: 126
Days worked without second TB test: 162
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Administrator | Provided interviews and statements regarding deficiencies and corrective actions |
| Staff B | Licensed Practical Nurse, Director of Health Services | Provided interview regarding respirator fit testing and tuberculosis testing |
| Staff F | Caregiver | Failed to have required background checks and tuberculosis testing prior to unsupervised resident contact |
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