Inspection Reports for Village Concepts of Issaquah-Spiritwood at Pine Lake

3607 228th Ave SE, Issaquah, WA 98029, United States, WA, 98029

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Deficiencies per Year

16 12 8 4 0
2022
2023
2024
2025
Unclassified

Census Over Time

63 66 69 72 75 78 Jul '22 Jun '25 Jun '25
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400 Civil fine amount: 300 Total civil fines: 1000 Resident census: 72 Number of pets: 4 Number of residents with outdated service agreements: 2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
NameTitleContext
Laurie AndersonField ManagerContact person for submission of Statement of Deficiencies and follow-up.
Matt HauserCompliance SpecialistSigned 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
NameTitleContext
Michelle YipALF LicensorDepartment staff who did the on-site verification
Kathy YoungLicensorDepartment staff who did the on-site verification
Thomas ForkgenALF LicensorDepartment 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
NameTitleContext
Jason Van GorkumDeputy State Fire MarshalConducted the inspection and signed the report
Brenda PajoExecutive DirectorOwner or Authorized Representative signing the report
Justin AlshierMaintenance DirectorOwner 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
NameTitleContext
Steven GarrettLTC LicensorDepartment staff who did the inspection and provided consultation.
Claudia MachadoCommunity Complaint InvestigatorDepartment staff who did the inspection and provided consultation.
Jane HermanoNCIDepartment staff who did the inspection and provided consultation.
Angelica RiosALF LicensorDepartment staff who did the inspection and provided consultation.
Laurie AndersonField ManagerSigned 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
NameTitleContext
Jason Van GorkumDeputy State Fire MarshalConducted the inspection and signed the report
Robert WilliamsMaintenance DirectorNamed 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
NameTitleContext
Mary HayesLicensorConducted the on-site verification and investigation
Laurie AndersonField ManagerSigned letters related to compliance determination and enforcement
Staff BHealth Services Director / Licensed NurseInterviewed regarding medication delegation and facility practices
Staff AAdministratorInterviewed regarding family assistance with medications and facility policies
Staff DMedication TechnicianInterviewed regarding medication administration and repositioning practices
Staff CMedication TechnicianInterviewed regarding medication administration and resident care
Staff EMemory Unit CaregiverInterviewed regarding resident observations and care

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