C75

BETHANY AT SILVER LAKE

Grade C 75/100 composite score

Non profit - Church related

CMS Star Ratings

Overall
5/5
Health Insp.
4/5
Quality
5/5
Staffing
3/5
RN Staffing
Not rated

Certified Beds

151

Ownership

Non profit - Church related

Total Fines

$130,758

Last Survey

N/A

2235 LAKE HEIGHTS DRIVE, EVERETT, WA 98208
4253383000

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Staffing Hours & Turnover

Hours per Resident per Day (PBJ)

RN
0.79h
LPN
0.59h
CNA
1.96h
Total
3.34h
Facility
State Average

Turnover Rates

RN Turnover
N/A
Total Nurse Turnover
N/A
Admin Turnover
N/A

Ownership

BETHANY OF THE NORTHWEST

Organization5% OR GREATER DIRECT OWNERSHIP INTERESTSince Oct 1999

100%

BAUGUESS, TRISTINE

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Feb 2025

LAGERSTROM, CHRISTINE

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Feb 2025

SCRIVENS, JOSEPH

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Dec 2019

TOOR, NAVDEEP

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Oct 2022

DEGROODT, PATRICIA

IndividualCORPORATE DIRECTORSince Feb 2023

DOBLER, ROBERT

IndividualCORPORATE DIRECTORSince Jan 2025

GAY, JEFF

IndividualCORPORATE DIRECTORSince Apr 2017

IHLE, LOREN

IndividualCORPORATE DIRECTORSince Jan 2025

JACOBSON, STEVEN

IndividualCORPORATE DIRECTORSince Jun 2018

KNUDSON, VERONICA

IndividualCORPORATE DIRECTORSince Jan 2025

KOENIG, DAVID

IndividualCORPORATE DIRECTORSince Mar 2007

NESSE, JANICE

IndividualCORPORATE DIRECTORSince Jan 2025

NICHOLSON, ERIC

IndividualCORPORATE DIRECTORSince Oct 2023

ROHDE, TOM

IndividualCORPORATE DIRECTORSince Jun 2018

SEYED ALIROTEH, MAHDIESADAT

IndividualCORPORATE DIRECTORSince Apr 2024

STAVE, LAWRENCE

IndividualCORPORATE DIRECTORSince Jan 2025

TIU, SUSAN

IndividualCORPORATE DIRECTORSince Jan 2019

WALLIN, TERRI

IndividualCORPORATE DIRECTORSince Jul 2020

SCRIVENS, JOSEPH

IndividualCORPORATE OFFICERSince Dec 2019

Penalties & Fines (3)

$130,758total fines
DateTypeDescriptionAmount
May 2, 2024Fine$51,500
Oct 31, 2023Fine$69,947
Apr 17, 2023Fine$9,311

Health Inspection Deficiencies (55)

December 20, 2024Health6 deficiencies
0561DMinimal harm, Isolated

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Resident Rights Deficiencies

Corrected Jan 30, 2025
0655EMinimal harm, Pattern

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Resident Assessment and Care Planning Deficiencies

Corrected Jan 30, 2025
0657EMinimal harm, Pattern

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Resident Assessment and Care Planning Deficiencies

Corrected Jan 30, 2025
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Jan 30, 2025
0585DMinimal harm, Isolated

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Resident Rights Deficiencies

Corrected Jan 30, 2025
0658DMinimal harm, Isolated

Ensure services provided by the nursing facility meet professional standards of quality.

Resident Assessment and Care Planning Deficiencies

Corrected Jan 30, 2025
May 2, 2024Health1 deficiency1 severe
0600GActual harm, Isolated

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jun 12, 2024
October 31, 2023Health21 deficiencies1 severe
0550EMinimal harm, Pattern

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Resident Rights Deficiencies

Corrected Dec 14, 2023
0578EMinimal harm, Pattern

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Resident Rights Deficiencies

Corrected Dec 14, 2023
0610DMinimal harm, Isolated

Respond appropriately to all alleged violations.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Dec 14, 2023
0625DMinimal harm, Isolated

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Resident Rights Deficiencies

Corrected Dec 14, 2023
0644DMinimal harm, Isolated

Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

Resident Assessment and Care Planning Deficiencies

Corrected Dec 14, 2023
0656DMinimal harm, Isolated

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected Dec 14, 2023
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Dec 14, 2023
0686GActual harm, Isolated

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Quality of Life and Care Deficiencies

Corrected Dec 14, 2023
0690DMinimal harm, Isolated

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Quality of Life and Care Deficiencies

Corrected Dec 14, 2023
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Dec 14, 2023
0756DMinimal harm, Isolated

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Pharmacy Service Deficiencies

Corrected Dec 14, 2023
0758EMinimal harm, Pattern

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected Dec 14, 2023
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Dec 14, 2023
0558DMinimal harm, Isolated

Reasonably accommodate the needs and preferences of each resident.

Resident Rights Deficiencies

Corrected Dec 14, 2023
0623DMinimal harm, Isolated

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

Resident Rights Deficiencies

Corrected Dec 14, 2023
0657DMinimal harm, Isolated

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Resident Assessment and Care Planning Deficiencies

Corrected Dec 14, 2023
0677DMinimal harm, Isolated

Provide care and assistance to perform activities of daily living for any resident who is unable.

Quality of Life and Care Deficiencies

Corrected Dec 14, 2023
0688DMinimal harm, Isolated

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Quality of Life and Care Deficiencies

Corrected Dec 14, 2023
0761EMinimal harm, Pattern

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.

Pharmacy Service Deficiencies

Corrected Dec 14, 2023
0811DMinimal harm, Isolated

Ensure that residents are assessed for appropriateness for a feeding assistant program, receive services as per their plan of care, and feeding assistants are trained and supervised.

Nutrition and Dietary Deficiencies

Corrected Dec 14, 2023
0812DMinimal harm, Isolated

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Dec 14, 2023
July 6, 2023Health1 deficiency
0842EMinimal harm, Pattern

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Aug 1, 2023
May 26, 2022Health26 deficiencies3 severe
0585EMinimal harm, Pattern

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Resident Rights Deficiencies

Corrected Jul 11, 2022
0600GActual harm, Isolated

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jul 11, 2022
0637DMinimal harm, Isolated

Assess the resident when there is a significant change in condition

Resident Assessment and Care Planning Deficiencies

Corrected Jul 11, 2022
0641DMinimal harm, Isolated

Ensure each resident receives an accurate assessment.

Resident Assessment and Care Planning Deficiencies

Corrected Jul 11, 2022
0656EMinimal harm, Pattern

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected Jul 11, 2022
0657EMinimal harm, Pattern

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Resident Assessment and Care Planning Deficiencies

Corrected Jul 11, 2022
0677EMinimal harm, Pattern

Provide care and assistance to perform activities of daily living for any resident who is unable.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0679EMinimal harm, Pattern

Provide activities to meet all resident's needs.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0684EMinimal harm, Pattern

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0686DMinimal harm, Isolated

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0689JImmediate jeopardy, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0690DMinimal harm, Isolated

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0692DMinimal harm, Isolated

Provide enough food/fluids to maintain a resident's health.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0758DMinimal harm, Isolated

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected Jul 11, 2022
0812FMinimal harm, Widespread

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Jul 11, 2022
0880KImmediate jeopardy, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Jul 11, 2022
0887DMinimal harm, Isolated

Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Infection Control Deficiencies

Corrected Jul 11, 2022
0943EMinimal harm, Pattern

Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jul 11, 2022
0550EMinimal harm, Pattern

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Resident Rights Deficiencies

Corrected Jul 11, 2022
0580DMinimal harm, Isolated

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Resident Rights Deficiencies

Corrected Jul 11, 2022
0582DMinimal harm, Isolated

Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

Resident Rights Deficiencies

Corrected Jul 11, 2022
0610DMinimal harm, Isolated

Respond appropriately to all alleged violations.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jul 11, 2022
0688FMinimal harm, Widespread

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Quality of Life and Care Deficiencies

Corrected Jul 11, 2022
0732CNo harm, Widespread

Post nurse staffing information every day.

Nursing and Physician Services Deficiencies

Corrected Jul 11, 2022
0756DMinimal harm, Isolated

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Pharmacy Service Deficiencies

Corrected Jul 11, 2022
0921FMinimal harm, Widespread

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Environmental Deficiencies

Corrected Jul 11, 2022

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Frequently Asked Questions

What is the CareGrader rating for BETHANY AT SILVER LAKE?

BETHANY AT SILVER LAKE in EVERETT, Washington has a CareGrader grade of C (Average), with a composite score of 74.5 out of 100. This grade is based on health inspections, staffing levels, quality measures, and penalty history from official CMS government data.

What is the CMS star rating for BETHANY AT SILVER LAKE?

BETHANY AT SILVER LAKE has an overall CMS star rating of 5 out of 5, a health inspection rating of 4/5, and a staffing rating of 3/5. CareGrader combines this with additional data to calculate an A-F grade.

How many health deficiencies does BETHANY AT SILVER LAKE have?

BETHANY AT SILVER LAKE has 55 health deficiencies on record from CMS health inspection surveys. Deficiencies are rated from A (minimal harm potential) to L (immediate jeopardy, widespread). View the full inspection timeline above for details on each deficiency.

Has BETHANY AT SILVER LAKE been fined?

Yes. BETHANY AT SILVER LAKE has $130,758 in total fines from CMS enforcement actions across 3 penalties.

How many beds does BETHANY AT SILVER LAKE have?

BETHANY AT SILVER LAKE has 151 certified beds with approximately 116 current residents (77% occupancy). The facility is located at 2235 LAKE HEIGHTS DRIVE, EVERETT, Washington 98208. It is a non profit - church related facility.

Data Disclaimer

Inspection data, staffing levels, and star ratings are sourced from CMS Medicare Nursing Home Compare and are largely self-reported by facilities. A 2019 GAO study found that 43% of facilities under-reported falls. CareGrader provides this data for informational purposes only and is not affiliated with CMS or Medicare. Always visit facilities in person before making a decision.