Inspection Reports for Village Concepts of Issaquah-Spiritwood at Pine Lake
3607 228th Ave SE, Issaquah, WA 98029, United States, WA, 98029
Back to Facility ProfileDeficiencies per Year
16
12
8
4
0
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Follow-Up
Census: 72
Deficiencies: 3
Jun 10, 2025
Visit Reason
The Department of Social and Health Services completed a follow-up visit to the assisted living facility to verify correction of previously cited deficiencies.
Findings
The facility was found to have multiple uncorrected deficiencies related to hand sanitation, pet health certifications, and resident service agreement updates, resulting in civil fines totaling $1,000. These deficiencies placed residents at risk of foodborne illness, disease transmission, and unmet care needs.
Deficiencies (3)
| Description |
|---|
| Failure to ensure one staff followed hand sanitation guidelines in the main commercial kitchen. |
| Failure to ensure four pets were current with examinations and veterinarian certification free of diseases transmittable to humans. |
| Failure to update two residents' Negotiated Service Agreements (NSA). |
Report Facts
Civil fine amount: 300
Civil fine amount: 400
Civil fine amount: 300
Total civil fines: 1000
Resident census: 72
Number of pets: 4
Number of residents with outdated service agreements: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Anderson | Field Manager | Contact person for submission of Statement of Deficiencies and follow-up. |
| Matt Hauser | Compliance Specialist | Signed the enforcement letter regarding civil fines. |
Inspection Report
Follow-Up
Census: 72
Capacity: 72
Deficiencies: 0
Jun 9, 2025
Visit Reason
The department completed an unannounced on-site follow-up inspection of the Assisted Living Facility to verify correction of previously cited deficiencies.
Findings
The facility was found to have no deficiencies at the time of the follow-up inspection on 08/04/2025, indicating that previously cited deficiencies were corrected. The follow-up verified compliance with Assisted Living Facility licensing requirements.
Report Facts
Residents sampled: 4
Total residents: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Yip | ALF Licensor | Department staff who did the on-site verification |
| Kathy Young | Licensor | Department staff who did the on-site verification |
| Thomas Forkgen | ALF Licensor | Department staff who did the on-site verification |
Inspection Report
Life Safety
Deficiencies: 12
Jul 9, 2024
Visit Reason
The Office of the State Fire Marshal conducted a fire safety inspection at the Spiritwood at Pinelake residential care facility to assess compliance with fire protection and life safety codes.
Findings
Multiple deficiencies were cited related to fire-resistance-rated construction inspection, door operation, sprinkler system testing, carbon monoxide detection, emergency lighting, power testing, fire/smoke damper inspection, and fire door inspection and testing. Several deficiencies were corrected during the inspection, but many required documentation or scheduled inspections to be completed.
Deficiencies (12)
| Description |
|---|
| Facility failed to provide paperwork for annual inspection of fire-resistance-rated construction. |
| Penetrations found in room 301D Electrical room and housekeeping room on 2nd floor. |
| Multiple fire doors and double doors on various floors will not latch properly. |
| Facility failed to provide paperwork for sprinkler system testing including annual report, 5-year internal pipe testing, 3-year dry system test, annual trip test, annual forward flow test, 5-year FDC hydro testing, and quarterly inspections. |
| Loaded sprinkler heads found in kitchen and resident laundry on 2nd floor, and hallway by room 142; some corrected during inspection. |
| Automatic fire-extinguishing systems serviced as required. |
| Fire alarm and fire detection systems inspection and testing schedules maintained. |
| Facility failed to provide paperwork for carbon monoxide alarms and detectors testing and maintenance on a monthly schedule. |
| Med cart found obstructing path of egress in elevator lobby. |
| Emergency lighting equipment inspected and tested; annual 90 minute power test paperwork not provided. |
| Periodic inspection and testing of fire/smoke dampers completed as required. |
| Facility failed to provide paperwork for fire door inspection and testing including schedule and documentation of inspections. |
Report Facts
Inspection date: Jul 9, 2024
Next inspection scheduled on or after: Aug 8, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason Van Gorkum | Deputy State Fire Marshal | Conducted the inspection and signed the report |
| Brenda Pajo | Executive Director | Owner or Authorized Representative signing the report |
| Justin Alshier | Maintenance Director | Owner or Owner's Representative signing the report |
Inspection Report
Annual Inspection
Deficiencies: 2
Nov 7, 2023
Visit Reason
The Department completed a full inspection of the Assisted Living Facility on 11/07/2023 to determine compliance with Assisted Living Facility requirements.
Findings
The facility failed to display clearly marked signage for first aid kits and did not maintain resident medications in original containers with pharmacy prescription labels. Five unlabeled medications were discarded during the inspection, and improved medication storage guidelines were implemented.
Deficiencies (2)
| Description |
|---|
| Facility did not display and have clearly marked signage for first aid kits. |
| Facility failed to maintain resident medications in original containers with original pharmacy prescription labels; five unlabeled medications were discarded. |
Report Facts
Unlabeled medications discarded: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steven Garrett | LTC Licensor | Department staff who did the inspection and provided consultation. |
| Claudia Machado | Community Complaint Investigator | Department staff who did the inspection and provided consultation. |
| Jane Hermano | NCI | Department staff who did the inspection and provided consultation. |
| Angelica Rios | ALF Licensor | Department staff who did the inspection and provided consultation. |
| Laurie Anderson | Field Manager | Signed the report as Field Manager, Region 2, Unit D. |
Inspection Report
Life Safety
Deficiencies: 14
May 10, 2023
Visit Reason
The Office of the State Fire Marshal conducted a fire safety inspection at the Spiritwood at Pinelake residential care facility to assess compliance with fire protection codes and regulations.
Findings
The inspection found multiple deficiencies including improper storage under sprinklers, use of equipment rooms for storage, unsafe extension cord usage, missing required paperwork for cleaning, maintenance, testing, and inspection of fire safety systems, malfunctioning fire doors, and missing directional signage. The facility was disapproved due to these violations.
Deficiencies (14)
| Description |
|---|
| Supplies stored under sprinkler in storage rooms on 3rd and 2nd floors |
| Electrical room and boiler room being used for storage |
| Storage room 321 had daisy chain power strips and extension cords improperly used |
| Second semi-annual hood cleaning paperwork not provided |
| Annual inspection of fire-resistance-rated construction paperwork not provided |
| Storage near residents' mailboxes, stairwell by resident room 103, above exit door in dish room, and above fire doors by kitchen not maintained |
| Corridor door and electrical door by resident room 341 will not latch |
| Fire/smoke damper 4-year inspection paperwork not provided |
| 5-Year internal pipe testing, 3-Year dry system full flow trip test, annual forward flow test, 5-year backflow internal pipe test, 5-year FDC hydro testing, and quarterly inspections paperwork not provided |
| First and second semi-annual servicing, annual replacement of fusible links/auto sprinkler heads, and NAFED certification paperwork not provided |
| Annual report, sensitivity testing, and nuisance log paperwork not provided |
| Carbon monoxide alarm found not working by resident mail room |
| Exit signs missing directional signage from courtyard to parking lot |
| Fire door annual inspection paperwork not provided |
Report Facts
Inspection date: May 10, 2023
Next inspection scheduled: Jun 12, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason Van Gorkum | Deputy State Fire Marshal | Conducted the inspection and signed the report |
| Robert Williams | Maintenance Director | Named as Owner or Authorized Representative signing the report |
Inspection Report
Complaint Investigation
Census: 70
Deficiencies: 4
Jul 21, 2022
Visit Reason
The inspection was conducted as a complaint investigation based on allegations of neglect of a named resident and medication mismanagement, as well as injury of unknown origin.
Findings
The facility failed to ensure proper repositioning of a resident every two hours, failed to administer medications as prescribed and lacked proper delegation and family treatment plans for medication administration. Additionally, the facility failed to prevent injuries and did not follow up with family to strategize safety measures. Multiple deficiencies related to medication administration, resident care, and emergency procedures were identified.
Complaint Details
The complaint investigation was based on allegations of neglect of a named resident, medication mismanagement, and injury of unknown origin. The investigation included interviews, record reviews, and observations. The complaint was substantiated with failed provider practices identified and citations written.
Deficiencies (4)
| Description |
|---|
| Facility failed to determine ability to safely provide care and services for Resident 1 when medication assistance exceeded facility's scope, leading to medication errors and diminished quality of life. |
| Facility failed to implement negotiated service agreement for repositioning Resident 1 every two hours, resulting in pressure ulcers. |
| Facility failed to ensure Resident 1 received medications as prescribed, placing resident at risk for pain, anxiety, and decreased quality of life. |
| Facility failed to implement policy for contacting 911 after Resident 3 exhibited bruising and swelling, delaying assessment and treatment of suspected head injury. |
Report Facts
Total residents: 70
Resident sample size: 3
Closed records sample size: 1
Investigation dates: 2022-06-24 to 2022-07-21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Hayes | Licensor | Conducted the on-site verification and investigation |
| Laurie Anderson | Field Manager | Signed letters related to compliance determination and enforcement |
| Staff B | Health Services Director / Licensed Nurse | Interviewed regarding medication delegation and facility practices |
| Staff A | Administrator | Interviewed regarding family assistance with medications and facility policies |
| Staff D | Medication Technician | Interviewed regarding medication administration and repositioning practices |
| Staff C | Medication Technician | Interviewed regarding medication administration and resident care |
| Staff E | Memory Unit Caregiver | Interviewed regarding resident observations and care |
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