The allegation surfaced in a grievance filed on August 12, 2025, but it didn't come from the resident herself.
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Inspectors reviewed three versions of the facility's assessment document.
Ten days later, she obtained a temporary RN license, but it was issued by Idaho, not Washington.
He arrived at the hospital fatigued, lethargic, and warm to the touch.
The admission came during a complaint inspection on November 16, 2025.
The next morning at 3:20 a.m., a registered nurse found the same resident face down on the floor, barely breathing, foaming at the mouth, unresponsive.
The plan was supposed to include measurable objectives, timetables, and specific goals tied to each resident's physical, psychosocial, and functional needs.
The previous Immediate Jeopardy citation had begun on December 21, 2024.
Inspectors determined the violation affected a few residents and assigned it the lowest level of harm, noting minimal harm or potential for actual harm.
Federal inspectors cited Evergreen Crossing and The Lofts following a complaint investigation completed November 14, 2025.
The facility's own administrator and director of nursing confirmed it during an interview on November 15, 2025, at approximately 12:30 in the afternoon.
The resident, identified in inspection records only as Resident B, did not receive his own scheduled morning medications that day.