Mirror Lake Village

Unsealed floor penetration in Building A, floor 2 electrical room.

Missing annual service report, weekly inspection logs, and monthly full load test records.

Missing annual forward flow test, quarterly reports; painted sprinkler heads; missing sprinkler in Building A floor 1 storage room.

Need to increase cleaning service to quarterly frequency.

Missing carbon monoxide detector in Building A, floor 1 laundry room; missing inspection records.

Missing second semi-annual service report for automatic fire-extinguishing systems.

Missing inventory and documentation of fire-rated construction locations and maintenance records.

Missing annual inspection tag on Building B, floor 1 fire extinguisher.

Missing records for 12 planned and unannounced fire drills; missing specific shift/quarter drills.

Missing documentation of fire/smoke damper inspections.

Loose gas tank found near kitchen soda machine.

Missing documentation for fire alarm system testing and deficiencies from previous inspection reports.

Dead bolt found on egress path at Building B, resident door 115.

Fire doors held open with trash cans or wedges; missing documentation for fire door inspections.

Facility failed to follow medication delivery policy; time-sensitive medications were not administered within the required timeframe.

Emergency water supply from hot water tanks was not accessible due to missing handles, hoses, or instructions.

Facility failed to investigate and document an unwitnessed fall resulting in injury for 1 resident.

Facility failed to ensure food safety practices; 2 of 11 kitchen staff lacked food worker cards.

Facility failed to complete a documented pre-admission assessment for 2 of 9 residents prior to move-in.

Facility failed to ensure 3 of 9 sampled residents had a written plan for family assistance with medication management.

Incomplete documentation for dishwashing temperatures and food cooking temperatures.

Staff failed to maintain sanitizing solution concentration logs and failed to clean/maintain the ice maker.

Facility failed to document service agreements or plans to monitor clinical needs for 8 of 9 residents.

Facility failed to complete a Washington State Name and Date of Birth background check for 1 of 6 staff members.

Facility failed to identify consultative behavioral health resources and provide individualized activities for EARC-SDC residents.

Facility failed to provide 6 of 9 residents with a signed copy of the facility's policy on accepting Medicaid as a payment source.

Facility failed to assess a resident's use of bed side rails for safety.

The licensee failed to document in two residents service agreements a plan to monitor and address interventions to meet the current needs.

The licensee failed to ensure two residents had a written plan for family assistance with medication management.

Facility needs to increase cleaning service to quarterly.

Missing second semi-annual service report.

Building A, floor 2 electrical room has a penetration in the floor.

Missing documentation that fire/smoke dampers inspection has been performed.

Facility missing 12 planned and unannounced fire drills; specific shifts (2nd shift Q2/Q3, 3rd shift Q3/Q4) were missing.

Missing annual flow test, quarterly reports; 10/2025 report showed painted heads; Building A, floor 1 hair salon storage room missing sprinkler.

Kitchen has a loose tank near the soda machine.

Missing detailed documentation and maps of fire-rated construction locations and annual inspection reports.

Building B, floor 1 path of egress at resident door 115 has a dead bolt.

Missing annual service report, weekly inspection logs, and monthly 30-minute full load tests.

Missing documentation/maps of CO detectors; Building A, floor 1 laundry room missing CO detector.

Building B, floor 1 fire extinguisher by room 112 missing annual inspection tag.

Building B, 3rd floor fire alarm amplifier annual testing is past due.

Multiple doors held open with trash cans or wedges; missing documentation/maps for fire doors; Building B double doors removed without showing they are not needed for fire/smoke protection.

Fire wall penetrations found in 2nd floor Memory Care laundry room and 1st floor kitchen electrical room.

Generator remote manual stop station was not installed per NFPA 110 requirements.

Cross corridor doors 37a and 43b (2nd floor) did not close/latch properly.

1st floor Library area has a tree obstructing the sprinkler head.

Failed to ensure two residents' side bed rails, attached to the residents' beds, were free from safety risks.

Failed to document in five residents’ Negotiated Service Agreements (NSA) the care needs and interventions for diagnoses and physician ordered medical treatments.

Facility failed to ensure 2 of 6 staff completed required annual continuing education training.

Facility failed to document written agreements, duration of use, or quarterly reevaluations for electronic monitoring in 2 residents' rooms.

Facility failed to provide proper nurse delegation training and supervision for staff administering medication to 2 residents.

Facility failed to document in writing an initial agreement to use electronic monitoring, the duration of use, and quarterly reevaluations for Resident 12. Resident 12's representatives installed equipment without facility knowledge, and the facility failed to disconnect it as required.

Facility failed to ensure 2 of 4 residents' side bed rails were free from safety risks, specifically regarding cushioning that created potential entrapment/suffocation hazards.

Facility failed to document in 5 of 15 residents' Negotiated Service Agreements the care needs, interventions for diagnoses, and physician ordered medical treatments, placing residents at risk for unmet care needs.

Facility failed to ensure 3 of 6 staff members were screened for Tuberculosis within the required three-day window of employment.

Facility failed to ensure annual service plan renewals were signed by residents or representatives for 6 of 10 sampled residents.

Facility failed to implement an effective respiratory protection program, specifically regarding N95 fit testing for staff, which was a repeat deficiency.

Medical devices (bed rails) for 3 of 3 residents were unsafe, posing an entrapment hazard; rails were not covered and lacked adequate safety documentation.

Failed to document care needs and interventions for diagnoses and physician ordered medical treatments in five residents' Negotiated Service Agreements (NSA).

Failed to ensure side bed rails for three residents were free of entrapment hazards.

Failed to document in writing an initial agreement, duration of use, and quarterly reevaluations for electronic monitoring for one resident.