Arbor Village Retirement & Assisted Living Community

Missing smoke detector sensitivity report.

Missing documentation for annual sprinkler system report, 3-year dry system full flow trip test, annual trip test, and annual forward flow test.

Facility failed to provide documentation for: 1. Annual Sprinkler System report, 2. 3-Year Dry System Full flow trip test, 3. Annual Trip Test, 4. Annual forward flow test.

Facility failed to provide documentation for the Smoke detector sensitivity Report.

Activity room has combustible materials on stove top; knobs were removed but stove can still be turned on.

Resident room 101 has an AC unit plugged into a power strip.

Electrical/mechanical room on 1st floor lacks 36 inches of clearance for electrical panels.

Unable to provide complete documentation for annual fire door inspection.

Resident room 315 has sprinkler head obstructed by a shelf in the closet.

Fire extinguisher in elevator room on 1st floor did not receive annual maintenance.

Oxygen storage room by 229 has combustible storage.

Smoking area has cigarette butts discarded in brush/ground and is not 25 feet from the building.

Resident room 306 has an extension cord in use.

Unable to provide documentation for semi-annual hood cleaning.

Unable to provide documentation for last fire/smoke damper testing.

Missing 3rd/4th quarter sprinkler reports; forward flow test required.

Multiple smoke detectors are older than 10 years; room 306 and 105 missing detectors.

Penetration in door (room 315), Independence Rehab door propped open, and doors 109, 103, elevator, and staff lounge do not latch properly.

HVAC closet in dining room has combustible storage.

Wellness Center on 1st floor has an unapproved heater.

Unable to provide record of annual fire wall inspection and/or repairs.

Missing escutcheon ring in hall by room 322; loaded sprinkler heads found in hall by room 316 and staff lounge.

Unable to provide service reports for kitchen suppression system for past 12 months.

Unsecured oxygen in 2nd floor oxygen room and resident room 109.

Staff E worked 41 shifts without completing required annual continuing education training.

Service plans for 4 of 5 residents were not updated to reflect current needs (Resident 4 wound care, Resident 6 CPAP use, Resident 7 insulin sliding scale, Resident 8 medication changes).

Laundry room ventilation was non-functional.

One staff member lacked a valid food worker card; the staff member renewed it during the inspection.

Facility failed to ensure 1 of 2 sampled night staff (Staff E) met training requirements.

8 of 8 surveyed rooms/areas lacked proper air flow/ventilation to the outside.

Housekeeping room ventilation was non-functional.

The facility failed to ensure one staff maintained a valid food worker card (referenced with WAC 246-215).

Failed to ensure 2 of 3 pets received regular veterinary exams, current vaccinations, and certification of disease-free status.

Failed to ensure Staff B completed a TB test upon hire.

Bathroom ventilation system was non-functional.

Hazardous chemicals (dish soap, spray adhesive, glue, hand sanitizer) were accessible to residents in unsecured cabinets and an unattended cart.

Staff failed to label resident medication containers on medication carts with resident names; labels were corrected during the inspection.

Use of unapproved multi-plug adapters and power strips.

Failure to provide documentation for annual/semi-annual hood cleaning.

Smoke alarm missing from room 326; some alarms were over 10 years old.

No documentation provided showing testing of CO detectors in the past 12 months.

Facility unable to provide documentation for their 30-second monthly emergency lighting activation test.

Combustible material stored in boiler rooms, mechanical rooms, or electrical equipment rooms.

Improper use of extension cords as permanent wiring.

Multiple doors failed to close/latch properly (Cross corridor, exit doors, linen room).

No documentation of 30-second monthly testing for emergency lighting in 12 months.

Emergency lights in the dining room (by private dining and by exit door) did not work properly during testing.

Fire alarm circuit breaker in the maintenance office is missing the required lock device (locking breaker in the 'ON' position).

Hazardous electrical conditions including frayed wiring.

Open junction boxes, missing covers, and unlocked electrical panels.

Facility unable to provide documentation for forward flow and 4th quarter sprinkler report.

Missing carbon monoxide alarms in the 3rd floor laundry, 2nd floor laundry, 1st floor laundry, and 1st floor lobby by fire place.

The kitchen does not have an exit sign showing which door is used as an emergency exit.

Unable to provide documentation for twelve planned and unannounced fire drills in the past 12 months; kitchen staff do not participate.

Facility failed to ensure 2 staff members completed required training (Orientation, Safety, CPR, First Aid, and continuing education).

Facility failed to follow CDC and DOH guidelines regarding respiratory protection/fit testing for 17 staff members.

Facility failed to maintain a clean living environment; common area carpets were significantly stained with dark brown and black spots.

Resident records were found filed together with other resident charts and documents, compromising confidentiality.

Facility failed to ensure 4 staff members were screened for Tuberculosis within three days of hire.

Facility failed to assess a resident's safe use of a medical lift and inform them of safety risks.

Facility lacked a back-up generator despite documentation claiming it was equipped with one.

Facility did not implement their grievance policy to respond to resident/representative concerns regarding facility conditions.

Facility failed to submit a request for a Washington State background check for 1 staff member prior to them having unsupervised contact with residents.

Facility failed to document individualized care plans addressing behaviors, anxiety, and elopement risks for 2 sampled residents.

Housekeeping carts containing hazardous chemicals were left unlocked and accessible to residents with cognitive deficits.

Three staff members were unable to explain the facility's mandated reporter policy for resident abuse and neglect.

Facility failed to evaluate and obtain sufficient personal information to establish baseline assessments for residents.