Alderwood Post Acute: Sexual Assault Investigation Failures - WA
The August 18 allegation at Alderwood Post Acute & Rehabilitation triggered a cascade of investigative failures that federal inspectors documented in September. No one conducted a thorough skin examination of the resident immediately after the report. Nobody notified the resident's power of attorney or physician. The facility didn't place the resident on alert monitoring to watch for psychological harm.
Most critically, when nursing staff discovered a skin tear around the resident's left labia on August 23, five days after the sexual assault allegation, managers failed to report the injury to state authorities or investigate whether it was connected to the alleged assault.
The accused employee worked a full shift on August 18 after the allegation was made. Staff A, identified in the inspection report as a supervisor, told the worker simply "not to work with Resident 1" that night. The employee wasn't officially suspended until August 22, four days later.
"No one told them that they were suspended, no one asked for a statement from them regarding the allegation," inspectors wrote, documenting an interview with the accused staff member on August 26.
The employee described receiving a suspension form on August 22 that had been signed "over phone" on the signature line, though no one had actually spoken to them about the form. They said it was the first time they had seen any documentation about the investigation.
Staff D, the Licensed Practical Nurse and Nurse Manager, acknowledged the facility's failures when questioned by inspectors on September 3. They admitted they had never actually examined the labia injury themselves, despite being notified about it on August 23.
"This resident has a lot of skin issues in other places, so they felt it was because they had fragile skin," the inspection report documented. But Staff D conceded that "due to the fact that this skin issue was in a concerning place and the resident's recent allegation of sexual assault, this concern should have been reported and investigated but they had not reported or investigated this."
The nursing progress note from August 23 described the injury as a "new skin tear around her left labia." No further documentation about this "injury of unknown origin" appeared in the resident's medical records.
Staff A, when shown the August 23 progress note during the September inspection, said it was "the first time they had heard of this and that this should have been reported to the state and investigated."
The facility's investigation protocol requires multiple steps that weren't followed. According to Staff A's own description to inspectors, proper procedure includes suspending the alleged perpetrator immediately, assessing the resident for injuries, documenting all findings, placing the resident on psychological monitoring, and obtaining statements from all staff who worked with the resident in the 48 hours before the allegation.
None of these steps were completed properly.
The former Director of Nursing Services, who was responsible for the initial investigation, had apparently left the facility by the time federal inspectors arrived in September. Staff A told inspectors the prior DNS "was the person responsible for investigating the initial report of sexual assault."
Federal inspectors found the facility failed to ensure residents were free from abuse and neglect, and failed to report suspected violations immediately to the administrator and other officials in accordance with state and local laws.
The inspection was conducted following a complaint. The facility received citations for minimal harm with potential for actual harm affecting few residents.
The resident who made the sexual assault allegation was left without proper medical evaluation, psychological support, or family notification during the critical days following their report. The discovery of a genital injury five days later, in the same area where sexual assault was alleged, went uninvestigated and unreported to authorities.
Washington state regulations require nursing homes to immediately report suspected abuse and conduct thorough investigations that protect residents from further harm. At Alderwood Post Acute, those protections failed when a vulnerable resident needed them most.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Alderwood Post Acute & Rehabilitation from 2025-09-03 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
ALDERWOOD POST ACUTE & REHABILITATION in LYNNWOOD, WA was cited for violations during a health inspection on September 3, 2025.
No one conducted a thorough skin examination of the resident immediately after the report.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.