01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-05-18 | 14 | 2026-05-18 | 5 |
| Cycle 2 | 2025-04-21 | 18 | 2025-04-21 | 8 |
| Cycle 3 | 2024-06-12 | 25 | 2024-06-12 | 14 |
CMS CCN 5054042026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Bethany At Pacific
916 Pacific Avenue 3Rd-5Th Floors · Everett, WA 98201 · Snohomish County
Certified beds80CMS provider file
Recent citation rows84current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
84 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 18 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-18 · FIREE0009Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Include a process for Emergency Preparedness collaboration.
Correction field: Deficient, Provider has date of correction · 2026-06-152026-05-18 · FIREE0039Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2026-06-152026-05-18 · HEALTHF0561Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0565Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to organize and participate in resident/family groups in the facility.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0628Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0646Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Notify the appropriate authorities when residents with MD or ID services has a significant change in condition.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0745Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0825Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or get specialized rehabilitative services as required for a resident.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · HEALTHF0908Severity F · widespread; potential for more than minimal harm
Environmental Deficiencies
Keep all essential equipment working safely.
Correction field: Deficient, Provider has date of correction · 2026-07-012026-05-18 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2026-06-152026-05-18 · FIREK0920Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2026-06-152026-05-18 · FIREK0923Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2026-06-152025-06-11 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2025-07-18 · complaint2025-04-21 · FIREE0006Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Correction field: Deficient, Provider has date of correction · 2025-05-192025-04-21 · FIREE0020Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures including evacuation.
Correction field: Deficient, Provider has date of correction · 2025-05-192025-04-21 · FIREE0025Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Create arrangements with other facilities to receive patients.
Correction field: Deficient, Provider has date of correction · 2025-05-192025-04-21 · FIREE0039Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2025-05-1903 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2024-04-17 | Fine | $42,477 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- DEGROODT, PATRICIAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/2023
- DOBLER, ROBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/23/2025
- GAY, JEFFIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/27/2017
- IHLE, LORENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/23/2025
- JACOBSON, STEVENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/27/2018
- KNUDSON, VERONICAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/23/2025
- KOENIG, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2007
- NESSE, JANICEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/23/2025
- NICHOLSON, ERICIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/26/2023
- ROHDE, TOMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/07/2018
- SEYED ALIROTEH, MAHDIESADATIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/04/2024
- STAVE, LAWRENCEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/23/2025
- TIU, SUSANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/03/2019
- WALLIN, TERRIIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/23/2020
- SCRIVENS, JOSEPHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/06/2019
- BASADA, MARLITAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2024
- BAUGUESS, TRISTINEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/25/2025
- MANN, HARPREETIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/25/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.80per resident day
RN hours1.12per resident day
Weekend nurse hours4.12per resident day
Staff turnover36.6%CMS reported field
06 / LOCAL RECORDS
Open the Everett ledger →Other published facilities nearby
Bethany At Silver Lake151 beds · CMS overall 5/554 citation rowsEverett Center100 beds · CMS overall 3/545 citation rowsEverett Transitional Care Services62 beds · CMS overall 4/537 citation rowsMadison Post Acute59 beds · CMS overall 3/596 citation rowsView Ridge Care Center70 beds · CMS overall 3/556 citation rows