NH LICENSED CN LICENSE LICENSED TYPE A SWING APPVD …Hospital Long Term Care Unit. Regency Canyon Lakes Rehabilitation and Nursing Center 1537 53 0 0 0 0 0 0 0 53 8/1/94 change of

Washington State Certificate of Need

Nursing Home Bed Supply Log

Avalon Care Center-Othello, LLC 1359 39 0 0 0 0 0 0 0 39

7/1/95 banked 8 beds; 7/1/97 bank 2 beds;

7/1/98 name chg-formerly Othello Conv Ctr.

10/1/98 banked 3 beds. 7/1/99 extension

denied, lost 8 beds.10/1/02 extend 3 banked

beds, 2 beds forfeited from 7/1/97. 12/17/03

CHOW aka Beverly Healthcare, 3 banked

beds forfeited. CHOW licensee banked 10

beds 3/09 BB09-14 - Voluntary relinq of 10

beds 9/29/10

East Adams Care Center, LLC 1509 0 0 0 0 0 0 50 0 50

11/12/98 banked 11 beds. 11/1/02-Extended

11 banked beds. 11/23/03-converted 11

beds. 06/14/04 rebanked 11 beds-38 months

remaining; no extension. Unbanked 11 beds

beginning 12-19-05 Part of March 2007

Settlement. 05/01/15 CHOW formerly Life

Care Center of Ritzville. 02/14/17 FFC

banked 50 beds 02/14/25

East Adams Rural Hospital N/A 0 0 12 0 0 0 0 0 002/02/17 approved to increase swing beds

from 5 to 12. [DOR 17-04]

Othello Community Hospital N/A 0 0 5 0 0 0 0 0 0 Swing Beds 10/04/02

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR ADAMS 39 0 17 0 0 0 50 0 89

Prestige Care & Rehabilitation-Clarkston 1455 90 0 0 0 0 0 0 0 90

Formerly Clarkston Care Center. CHOW

10/01/12 formerly Eagle Rehab at Clarkston

Tri-State Memorial Hospital N/A 0 0 5 0 0 0 0 0 0 8/13/04 approved for 5 swing beds

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR ASOTIN 90 0 5 0 0 0 0 0 90

Life Care Center of Kennewick 1381 136 0 0 0 0 0 0 0 136

11/1/98 bank 12 beds.11/1/02-extended 12

BB. All 12 beds converted 09/25/05. Part of

March 2007 Settlement. Converted 12 beds

May 2007(07-05 & 07-36) effective 1-30-08

Life Care Center of Richland 1383 104 0 0 0 0 0 0 0 104

9/1/95 bank 9 beds. 9/1/99 extend to 9/1/03.

10/01/01 bank 17 beds.6/1/03- Convert

11beds. 11/23/03 all 15 BB converted. Part of

March 2007 Settlement - BB Mod 7/08 - 2

bed extension 09-04 - 09-08 Ext of last 2 BB -

Conv of 2 beds 3/10. Conv 13 beds 6/2010

Prosser Memorial Hospital Long Term

Care Unit (CN #1743 issued 08/31/18) 0 0 0 36 0 0 0 0 36

CN #947 issued 7/88-complete - FFC

10/2010 of 36 bed unit. FFC beds expire on

9/2/18. 08/31/18 CN #1743 issued to Prosser

Memorial Hospital for a 36-bed NH in

Richland to be named: Prosser Memorial

Hospital Long Term Care Unit.

Regency Canyon Lakes Rehabilitation

and Nursing Center 1537 53 0 0 0 0 0 0 0 53

8/1/94 change of operator; 1/4/96 RA#001;

4/10/98 RA complete, name chg-formerly

Vistavue Care Center (closed 4/25/98).

06/01/16 CHOW formerly Canyon Lakes

Restorative and Rehabilitation Center.

09/01/17 Name change only-formerly

Regency Kennewick Rehabiltation and

Nursing Center

SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8

+NURSING HOME BED INVENTORY - BY COUNTY

NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS

COMMENTS/NOTESUPCOMING

BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

printed 1/7/2020...12:11 PM 1 of 30

DOH 260-023 January 2020



SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Richland Rehabilitation Center 1452 71 0 0 0 0 0 0 0 71

6/30/95 bank 14 beds; (see Order); convert

date extend to 6/30/01 per Order - addtl 2 yr

extend to 6/30/03; 3/23/00 convert all 14 beds

back to skilled nursing use. 9/27/00 RA #032

issued for replacement of Walnut Grove

Nursing Home. 12/29/04 Replace facility- was

known as Walnut Grove Nursing Home.

CHOW 10/01/12 no name change.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR BENTON 364 0 0 36 0 0 0 0 400

Cascade Medical Center CLOSED 0 0 5 0 0 0 0 0 03/96 name change, formerly Cascade

General Hospital

Cashmere Care Center 1588 65 0 0 0 0 0 0 0 65

Banked 12 beds 6/07 - Jan 2010 voluntary

relinquishment of 24 beds (including 12

banked & 12 licensed). 08/28/13 approved to

bank 21 beds under AU. 9/1/13 DSHS

identified AU bb approval. 08/17/17 Request

to convert 21 AU banked beds not timely.

Loss of 21 AU beds. Year 2017 CHOW &

name change. formerly Cashmere

Convalescent Center. 02/15/19 CHOW & no

name change.

Central Washington Hospital N/A 0 0 0 0 0 0 22 0 22

6/14/93 CN #917RA - TCU FFC closure

(BB10-02) of 30 beds effective 7-31-09; CN

#1454 issued on 9/13/11 approving a 22 bed

TCU. 11/15/18 approval for 22 FFC banked

beds 10/31/26

Colonial Vista Post Acute & Rehabilitation

Center 1541 100 0 0 0 0 0 0 0 100

1/1/94 name change; 11/8/96 RA #012;

5/8/98 name chg-formerly Colonial Vista

Village Care & Rehab Ctr; 8/1/00 CHOW.

01/06/17 CHOW & name change-formerly

Colonial Vista Care Center

Lake Chelan Community Hospital CLOSED 0 0 5 0 0 0 0 0 0

Regency Wenatchee Rehabilitation and

Nursing Center 1539 55 0 0 0 0 0 0 0 55

7/1/95 bank 6 beds; 5/1/96 chg owner; lost 6

beds per CHOW; 10/1/98 bank 14 beds.

4/01/01 banked 5 beds.14 beds banked

10/01/98 forfeited.03/04/05-Extended 3 beds

banked on 04/01/01 to 04/01/09, loss of 2

beds. 3 Beds lost with expiration of BB on

4/1/09. 09/03/13 Replacment Authorization

issued to relocate from Chelan to Wenatchee.

08/01/16 CHOW & name change-formerly

Regency Manor.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR CHELAN/DOUGLAS 220 0 10 0 0 0 22 0 242

Avamere Olympic Rehabilitation of

Sequim 1374 125 0 0 0 0 0 0 0 125

7/6/98 CN #1180 issued to consolidate

Olympic Health Care (60 beds) and Sherwood

Manor (65 beds) for a 125 bed facility. DSHS

licensed. 02/01/05 CHOW type: CHOPR was

Olympic Health Care, new licensee is Sequim

Rehab, LLC. Formerly Olympic Care and

Rehabilitation Center

printed 1/7/2020...12:11 PM 2 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Crestwood Health and Rehabilitation

Center 1562 101 0 0 0 0 0 0 0 101

11/1/95 change owner; 8/1/99 banked 6

beds.7/14/01-11 beds banked. 10/13/02,

convert 3. Extend BB of 8/1/99 to 8/3/07.

11/23/04 3 beds converted, 11 remain

banked. Extend 5 beds banked on 07/14/05-

no further extensions. Conv 6 beds 07-42 &

Conv 5 beds 07-45 - Reduced at licensee

request - See DSHS letter - RA 63 tranfered

11 beds to Sequim/Port Angeles. 3/18/13

name change: formerly Crestwood

Convalescent Center. 7/1/15 CHOW.

12/01/17 CHOW.

Forks Community Hospital N/A 12 0 25 0 0 0 0 0 12

3/18/02-Voluntary forfeiture of 16 LTC beds.

20 LTC beds remaining. 05/26/16 relinquish 8

LTC beds, for a total of 12.

Sequim Health and Rehabilitation Center 1563 100 0 0 0 0 0 0 0 100

7/1/95 bank 14 beds; Change general

partner, PFP Alpha Corp to become general

partner; 4/1/98 volunt. forfeit 14 banked beds-

CHOW-Fir Lane Conv Ctr Inc operator.

04/15/98 banked 13 beds.5/1/02 extend 13

beds, date corrected by DSHS, 8 yr expiration

05/01/06.7/1/01-5BB. 02/1/04 CHOW 18

beds converted. 02/14/04 18 beds banked,

Expiration date extended 2 days

only.11/24/04 Convert 3 BB, 15 beds remain

banked.03/01/05 2 beds converted. 08/22/25

all 13 beds converted. Delicensed and

decertified 11 beds with DSHS 9-22-05 -

added 11 back from other facility in RA63.

7/1/15 CHOW.Name change: formerly

Sequim Nursing and Rehabilitation Center.

12/01/17 CHOW.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR CLALLAM 338 0 25 0 0 0 0 0 338

Avamere Rehabilitation of Cascade Park 1508 88 0 0 0 0 0 0 0 88

4/95 new facility. 2/01/99 CHOW. 04/01/15

CHOW formerly Cascade Park Care Center

Brookfield Health and Rehabiltation of

Cascadia 1552 83 0 0 0 0 0 0 0 83

7/1/97 chg of oper-Eagle HC.6/30/01-8

BB.06/30/05 extended 8 beds-expire

06/30/09=no extension. Converted all 8

effective 7-2-07 - CHOW 8-1-07 formerly

Parkway North. 12/12/16 name change only-

formerly Victory Health & Rehab of Battle

Ground. 09/01/17 CHOW formerly Victory

Rehabilitation and Healthcare Center

Discovery Nursing & Rehab of Vancouver 1353 89 0 0 0 0 0 0 0 89

1/1/95 formerly Whispering Pines Care

Center; 4/7/98 name chg-formerly Covington

Med & Rehab Ctr. 6/1/99 name chg-formerly

Sunrise Care & Rehab for

Vancouver.10/01/03-CHOW from Sunbridge

Care & Rehab for Vancouver. 04/01/04-Name

Change formerly Hazel Dell Nursing & Rehab

Center.

Fort Vancouver Post Acute 1527 92 0 0 0 0 0 0 0 9211/01/15 CHOW-formerly Fort Vancouver

Convalescent Center

printed 1/7/2020...12:11 PM 3 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

ManorCare Health Services - Salmon

Creek 1594 120 0 0 0 0 0 0 0 120

4/4/08-CN #1366 issued for estab of 120 bed

NH in Clark County. While this approval was

under adjudicative appeal, HLJ Kuntz

approved a stay of the commencement date.

Once the appeal was withdrawn, the stay was

lifted, resulting in the issuance of CN #1366E

with an expiration date of 11/13/10. 08/05/18

CHOW. 01/01/20 CHOW

Prestige Care & Rehabilitation-Camas 1450 83 0 0 0 0 0 0 0 83

1/1/95 change of ownership; 6/30/95 bank 41

beds; convert date extend to 6/30/01 per

Order - addtl 2 yr extend to 6/30/03.06/30/01

bank 7 beds.41 beds banked 6/30/95

forfeited. 06/30/05-7 beds extended until

06/30/09; no extension. Loss of 7 BB with

exp of BB timeline. CHOW 10/01/12 formerly

Highland Terrace Nursing Center.

The Oaks at Timberline 1569 98 0 0 0 0 0 0 0 98

name chg-formerly Hillhaven Conv Ctr; 7/1/98

oper chg. Name chg formerly Vencor of

Vancouver. Formerly Vancouver Health and

Rehabilitation Center. 12/20/17 CHOW.

Fomerly Kindred Transitional Care and

Rehabilitation-Vancouver.

Vancouver Specialty and Rehabilitative

Care 1572 104 0 0 0 0 0 0 0 104

6/30/95 bank 11 beds DSHS licensed on

9/1/95; 1/96 formerly Emerald Terrace

Nursing; 7/1/96 bank 17 beds; 7/1/97 bank 13

beds. Extended 11 beds banked on 9/1/95 to

7/1/2003 (these beds cannot be extended

another 4 years); 7/1/00 forfeit 17 beds (letter

sent 6/15/00). Reminder mailed 1/18/01 for 13

beds banked 7/1/97. 3/29/01 extended 13

beds banked on 7/1/97 to 7/1/05 (these beds

cannot be extended another 4 years).

Forfeited 3 beds due to expire on 9/1/03.

Converted 8 beds due to expire on 9/1/03. 13

beds remain banked. 11/01/03 all beds

converted. 5/09 voluntary relinquishment of

17 beds - Voluntary req. to delicense 11 beds

rc'vd 11/30/09. 7/1/15 CHOW. 04/18/18

CHOW-formerly Pacific Specialty and

Rehabilitative Care.-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR CLARK/SKAMANIA 757 0 0 0 0 0 0 0 757

Booker Rest Home Annex N/A 23 0 0 0 0 11 0 0 34

Reduced from 46 to 34 as part of the

conversion of license to Dayton Hospital.

11/29/17 AU bed banking for 11 beds. 11/29/21

Dayton General Hospital N/A 0 0 5 0 0 0 0 0 0

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR COLUMBIA 23 0 5 0 0 11 0 0 34

Americana Health and Rehabilitation

Center 1223 74 0 0 0 0 0 0 0 74

10/94 change of owner;5/1/97 chg of

operator; name chg-formerly Americana Conv

Home; 5/1/98 bank 8 beds; 6/10/98 bank 2

beds. 5/1/02 extend 8 banked beds, 6/1/02

extend 2 banked beds. Missed 90 deadline

and relinquished 8 beds effective May 1, 2006

- Unbanked 2 remaining beds 5/21/06

printed 1/7/2020...12:11 PM 4 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Beacon Hill Rehabilitation 1466 67 0 0 0 0 0 0 0 67

7/1/98 oper chg. 3/1/02-5 beds banked. -

extended to 2010 - BB08-27 banked 2

additional beds for remaining 29 months.

Voluntary relinquishment of 5 beds and

denied conversion of 2 BB in 8/2010.

Formerly Northwest Continuum Care Center.

7/1/14 CHOW formerly Kindred Transitional

Care & Rehab-Beacon Hill.

Frontier Rehabilitation and Extended Care

Facility 1225 140 0 0 0 0 0 0 0 140

10/94 change of owner; 5/1/97 chg of

operator; name chg-formerly Frontier

Extended Care Fac. 09/01/03-6 beds banked.

Loss of 6 beds 4yr BB expiration

Park Royal Health and Rehabilitation

Center CLOSED 0 0 0 0 0 0 50 0 50

4/29/99 CHOW. CHOW 2/1/03-was Park

Royal Medical.09/01/03-17beds banked.

Unbanked 5 in amended app on 10-12-06 -

lost 12 beds in 4 yr expiration of BB. 50 beds

banked effective 08/16/19 08/16/27

Woodland Convalescent Center 749 62 0 0 0 0 0 0 0 62

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR COWLITZ 343 0 0 0 0 0 50 0 393

Ferry County Memorial Hospital-TCU CLOSED 0 0 4 0 0 0 0 0 0

Voluntary closed 6-30-04 - Cited 18 beds ((14

LTC / 4 Swing); Did not bank any of the beds

under FFC

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR FERRY 0 0 4 0 0 0 0 0 0

Avalon Health & Rehabilitation Center-

Pasco 1362 108 0 0 0 0 0 0 0 108

7/1/95 name change; formerly Hillcrest

Convalescent Center. 12/17/03 CHOW aka

Beverly Healthcare Pasco. Banked 17 beds

3/09 BB09-15. 12/18/12 4 year extension on

17 AU beds. 03/01/17 17 AU banked beds

expired

Our Lady of Lourdes Hosp-LTC U CLOSED 0 0 5 0 0 0 0 0 0

9/15/04 approval for 5 swing beds. 04/01/05

21-bed TCU (SNF) closed; FFC BED

BANKING NOT REQUESTED. ALL 21

BEDS RELINQUISHED.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR FRANKLIN 108 0 5 0 0 0 0 0 108

Garfield County Memorial Hospital CLOSED 16 0 5 0 0 0 20 0 36

Per 9/12/01 ltr from Byron Plan-Hospital

relinquished 4 NH beds. Hospital has 9 AC

and 36 NH beds. 10/16/02 of the 9 AC beds,

5 are swing. 01/18/112 FFC of 20-bed TCU

unit 01/18/20

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR GARFIELD 16 0 5 0 0 0 20 0 36

Columbia Basin Hospital N/A 12 0 6 0 0 0 0 0 12

CN #801 appvd 6 swing beds. Before 2011,

hospital had 50 SNF beds; 2011 reduced the

SNF beds from 50 to 29; in 2013, reduced the

SNF beds from 29 to 16; in 2014, reduced the

SNF beds from 16 to 12.

printed 1/7/2020...12:11 PM 5 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Columbia Crest Center 1504 111 0 0 0 0 0 0 0 111

CN #1147 issued 6/11/96; 11/1/97 licensed

20 CN appvd beds; 4/6/98 name chg-formerly

Terrace Heights Nsg Care Ctr. 6/1/99 name

chg-formerly Sunrise Care & Rehab for

Moses Lake.06/01/05 31 beds banked. Ext of

31 beds 09-12; formerly SunBridge Care &

Rehab for Moses Lake. 31 beds conv 8/2010.

02/25/14 name change-formerly Columbia

Crest Care & Rehabilitation Center. 2/1/15

CHOW.

Coulee Community Hospital CLOSED 0 0 5 0 0 0 0 0 0October 2007, closed NH portion of facility;

did not bank 29 beds under FFC.

Lake Ridge Center 1506 74 0 0 0 0 0 0 0 74

9/9/94 Sunrise Health new operator; 4/6/98

name chg-formerly Lake Ridge Care Center.

6/1/99 name chg-formerly Sunrise Special

Care Center - Lake Ridge; formerly SunBridge

Special Care Center - Lake Ridge; name

change formerly Lake Ridge Solana

Alzheimers Care Center. 2/1/15 CHOW .

McKay Healthcare & Rehab Center 867 42 0 0 0 0 0 0 0 42 10/1/98 name chg-formerly McKay Memorial

Quincy Valley Hospital N/A 0 0 5 0 0 0 0 0 0

CN #802 appvd 6 swing beds (5 are exempt,

& 1 is counted as SNF bed); CN #921 appvd

22 bed SNF. 12/31/07 NH closed.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR GRANT 239 0 16 0 0 0 0 0 239

Grays Harbor Health and Rehabilitation

Center 1356 105 0 0 0 0 0 0 0 105

1/96 formerly Grays Harbor Convalescent

Center; 7/1/95 bank 18 beds-DSHS delic. 19

beds prior to CN approval-lost 1 bed. 10/1/98

bank 14 beds. 7/1/99 extension denied, lost

18 beds. 3/1/01 banked 1 bed. 10/1/02-6

beds extended, 9 forfeited.12/01/03 CHOW-

Avalon Care Center Aberdeen, 6 banked

beds forfeited. BB09-25 banking of 16 beds.

03/04/13 4-year extension on AU banking of

16 beds. 06/01/17 16 AU banked beds

relinquished=license remains at 105.

Mark Reed Hospital N/A 0 0 5 0 0 0 0 0 0 1/27/83 approved for 5 swing beds

Montesano Health and Rehabilitation 1530 94 0 0 0 0 0 0 0 94

CN #970 replace 37 bed Edgewood and add

23 beds to rename Hillview Care Ctr; CN

#970A cost amendmt., replace 37 bed

Edgewood and 34 bed Woodland Terrace

and add 23 beds; 7/3/97 MDC cert-lic. 94

beds; 9/1/98 name chg-formerly Montesano

Med & Rehab Ctr.6/1/99-name chg from

Sunrise Care & Rehab for Montesano.

05/01/04 CHOW, licensee is CPL Delaware-

named changed from Sunbridge Health and

Rehab for Montesano. 12/1/15 CHOW

Pacific Care and Rehabilitation 1477 109 0 0 0 0 0 0 0 109

2/95 change operator; 6/1/98 owner chg.

11/1/00 CHOW. 08/01/03 CHOW.05/01/2004-

9 beds relinquished. CHOW 8-1-06 New

Operator: Hoquiam Healthcare, Inc. Formerly

Hoquiam Helathcare dba Pacific Care Center.

9/3/14 CHOW for licensing only.

-------- -------- -------- -------- -------- -------- -------- -------- --------

printed 1/7/2020...12:11 PM 6 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

BED COUNT FOR GRAYS HARBOR 308 0 5 0 0 0 0 0 308

Careage of Whidbey 1094 112 0 0 0 0 0 0 0 112

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR ISLAND 112 0 0 0 0 0 0 0 112

LifeCare Center of Port Townsend 1196 94 0 0 0 0 0 0 0 94

6/1/96 Life Care Centers purchased as limited

partnership. 03/01/03-19 BB. 7/15/03 forfeit 2

beds-17bb. 01/23/04 Order to reinstate 2

beds forfeited and convert all 19 beds

effective 12/31/03. 12/14/04 19 beds banked

03/01/03 rebanked-38 months remaining on

initial time. Part of March 2007 Settlement -

BB Ext BB-08-07 - Conversion of 19 beds

requested, approved, then withdrawn by

facility 12/2008 - Name change 5/2010 former

Kah Tai Care Center

Jefferson General Hospital N/A 0 0 5 0 0 0 0 0 0 Swing Beds 9/11/02

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR JEFFERSON 94 0 5 0 0 0 0 0 94

Anderson House CLOSED 0 0 0 0 0 0 112 0 11206/30/17 CLOSED. 08/17/17 FFC bed

banking 06/30/25

Avalon Care Center-Federal Way 1355 120 0 0 0 0 0 0 0 120

6/30/95 bank 14 beds; RA #015 issued

8/18/97 - lost 14 banked beds per RA;

4/27/98 CN #1176 issued to add 50 beds to

replacement facility formerly known as

Monarch Care Center. 7/02 project

authorized by CN #1176 was downsized-only

24 beds were added (rather than 50 beds) for

a facility total of 120 at project

completion.12/17/03 CHOW aka Beverly

Health & Rehab of Federal Way. Change in

Landlord 12/01/03-12/31/03 TOGII, LLC;

effective 01/01/05=The ARBA Group-no

change in ownership lease in facility file.

Bailey-Boushay House 1106 35 0 0 0 0 0 0 0 35

Ballard Center 1503 142 0 0 0 0 0 0 0 142

7/1/96 banked 61 beds; 7/1/97 convert 5

beds; 7/1/97 bank 4 beds; 11/15/99 bank 8

beds; 5/16/00 lost 47 beds because good

cause for extension not shown; 13 beds

extended to 7/1/04; 10/1/00 banked 8 beds.

10/02-4 beds forfeited, 17 converted back.

CHOW 03/01/03 from Integrated Health

Services. 3/1/03-17 BB - Name change

from Whittier to Ballard - 2 Beds lost for

Inappropriate use approx 3/06 - 15 beds

lost March 1, 2007 for Timeliness of BB;

04/23/2014 name changed formerly Ballard

Care and Rehabilitation Center. 2/1/15

CHOW.

Bayview Manor 461 50 0 0 0 0 0 0 0 50

Benson Heights Rehabilitation Center 1363 91 0 0 0 0 0 0 0 91 12/01/03, CHOW-Avalon Care Center Kent

printed 1/7/2020...12:11 PM 7 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Briarwood at Timber Ridge [Type A

CCRC] 1413 0 45 0 9 0 0 0 0 0

Type A CCRC. CN 1312 approved 07/07/05

for Talus facility for 36 bed NH. 05/13/13 CN

#1503 issued to Horizon House to unbank 56

FFC beds and relocate them at this site. At

completion, Type A CCRC is closed and the

new facility [Briarwood Health Care] is a

community based nursing home. CN #1503

RELINQUISHED ON 06/03/14. FFC BEDS

ARE ALSO EXPIRED. TYPE A CCRC OF

BRIARWOD REMAINS AS TYPE A NH.

12/22/14 add 9 more typeA CCRC beds for a

facility total of 45.

Burien Nursing and Rehabilitation Center 1583 140 0 0 0 0 0 0 0 140

1/96 change owners; name chg-formerly

Burien Nursing Center; 29 beds banked

11/01/98. Name change, formerly Burien

Terrace. Extended 29 beds to 11/01/06.

3/12/03-Converted 5 beds - Converted 24

beds (07-06 & 07-34) effective Oct 31, 2007.

Formerly Life Care Center of Burien. 08/23/18

CHOW no name change.

Canterbury House 1269 100 0 0 0 0 0 0 0 100

7/18/97 name chg-formerly Canterbury

House; 10/1/98 CHOW; 4/01/01 name chg-

back to Canterbury House from Canterbury

Rehab

Caroline Kline Galland Home (The) 658 205 0 0 0 0 0 0 0 205

Columbia Lutheran Home 48 116 0 0 0 0 0 0 0 116

4/16/98 bank 6 beds; 3/15/00 CN #1205

issued for a post completion renovation

project. Extension denied-forfeited 6 beds.

Corwin Care Center at Emerald Heights

Type A CCRC 1113 0 61 0 0 0 0 0 0 0

4/1/94 name change; 10/1/97 bank 2 beds;

5/1/98 bank 2 beds Note: these banked beds

are not counted in the banked bed supply

because the facility's beds total beds are not

counted in county supply.

Covenant Shores Health Center 1231 43 0 0 0 0 0 0 0 43 CN #1090 issued 6/3/93

Cristwood Nursing and Rehabilitation 274 168 0 0 0 0 0 0 0 168

AU 06-60 - Banked 8 beds - name changed

from Crista Senior Community - Ext 8 beds

BB10-12. Voluntary relinq of 8 beds 12/11

Enumclaw Community Hospital N/A 0 0 5 0 0 0 0 0 0 Swing Bed App Rcd 6-24-2005

Enumclaw Health and Rehabilitation

Center 1266 92 0 0 0 0 0 0 0 92

8/1/96 chg owner (Unison HC); name chg-

formerly Franciscan HC Ctr @ Enumclaw;

11/1/96 bank 20 beds; 11/1/96 bank 3 beds;

6/1/98 convert 23 beds; 8/1/98 owner/name

chg-formerly Enumclaw HC & Rehab Ctr.

11/9/98 banked 31 beds. 11/9/02-extend 30

beds, 1 forfeited. Expires 11/9/06 (can't be

extended).09/01/03 25 beds banked, exp

9/1/07. Conv 30 beds 7-31-06 - lost 25 beds

in expiration of 4 yr BB - Voluntary reduction

of 30 beds effective 1/1/09

Foss Home and Village 417 211 0 0 0 0 0 0 0 211

printed 1/7/2020...12:11 PM 8 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Garden Terrace Healthcare Center of

Federal Way 1350 70 0 0 0 0 0 0 0 70

7/1/94 Cascade Care Centers = new

operator; 1/5/96 RA#004 replaces bldg.-fac.

closed until completed.10/01/03 New

Licensee- Federal Way Medical Investors.

08/01/15 name changed from Garden Terrace

Alzheimer's Center of Excellence. 2018 name

change; formerly Garden Terrace Alzheimer's

Center of Federal Way.

Hallmark Manor 1076 147 0 0 0 0 0 0 0 147

11/9/98 banked 18 beds. 8/23/00 approved to

convert 18 beds back to SN use. 09/1/00

banked 12 beds. 11/1/01 Banked 8

beds.06/28/04 Loss of 8 beds during

conversion request, awaiting license

modification Part of March 2007 Settlement -

Modified 2 beds May 2007 - BB08-19

Conversion of 5 beds - BB09-07 conv

remaining 3 beds

Health and Rehabilitation of North Seattle CLOSED 0 0 0 0 0 0 119 0 119

9/1/03-Name Change from Greenwood Park

Care Center.9/1/03 15 beds banked-exp

9/1/07.Relinquish 6 beds banked 09/01/03.

relinquished another 17 beds 10/12/05 to

revise total - loss of 9 beds with BB

expiration. 01/22/18 FFC bed banking for 119

beds. 01/22/26

Hearthstone, The 527 40 0 0 0 0 4 0 0 44

7/8/97 RA#014; 6/1/97 bank 7 beds.

Reminder mailed 1/18/01 for 7 beds banked

6/1/97. 3/5/01, extension granted for 7 beds

to 6/1/2005.Loss of 7 beds banked 06/01/97.

02/24/17 BB #17-02, AU bank 4 beds. 02/24/21

Highline Community Hospital CLOSED 0 0 0 0 0 0 30 0 30

CN #1097 10/4/93; reduce beds by 9 to NW

Reg Resp & Complex Care Consort. 04/2/12

FFC bed banking for 30 beds. 04/02/20

Ida Culver House Broadview Nursing

Care Center 1065 74 0 0 0 0 0 0 0 74

Issaquah Nursing and Rehabilitation

Center 1582 140 0 0 0 0 0 0 0 140

7/1/98 oper chg. 12/4/98 banked 2 beds.

3/1/00 CHOW- lost 2 beds. Previously named

Issaquah Care Center & The Gardens at

Issaquah - License cites Issaquah Nursing &

Rehab Ctr - Voluntary relinquishment of 40

beds 7/2009. 08/23/18 CHOW no name

change.

Judson Park Health Center 797 96 0 0 0 0 0 0 0 96

3/1/96 - bank 4 beds; 1/1/00 4 year extension

on 4 beds to 3/1/04. 12/31/01 banked 16

beds. Relinquished an additional 12 beds. 4

beds banked on 3/1/96 forfeited, untimely

request.12/29/04 conversion of 8 bb. Extend

8 beds -expire 12/31/09. 8 beds lost in BB

exp

Keiro Northwest CLOSED 0 0 0 0 0 0 150 0 150

4/1/96 RA#007. 10/07/16 name change-

formerly Seattle Keiro. BB20-04 -- Full

Facility closure 9/12/2019. On September 12,

2019, 150 beds banked. 09/12/27

Kin On Health Care Center 1221 100 0 0 0 0 0 0 0 100

CN# 1082 minority beds owned by Chinese

Nursing Home Society; 6/17/94 name chg per

HUD req's. (formerly Kin On Nursing Home

operated & leased 63 beds from Nikkei

Concerns dba Seattle Keiro)

printed 1/7/2020...12:11 PM 9 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Lea Hill Rehabilitation and Care Center 1551 36 0 0 0 0 0 0 0 36

CN #1534 issued on 10/06/14 approved the

establishment of a 36-bed M/M nursing home.

The 36 beds came from the FFC banked

beds at Bessie Burton Sullivan. CN #1534R

issued on 05/15/15 reduced the capital

expenditure but the number of beds remain at

36. 08/18/17 name change-formerly Skilled

Nursing Facility Managed by Wesley Homes.

Life Care Center of Kirkland 1419 190 0 0 0 0 0 0 0 190


partnership. Chow 1/09 aka Lake Vue

Gardens Convalescent Center

Life Care Center of West Seattle CLOSED 0 0 0 0 0 0 106 0 106

5/96 LifeCare purchased as limited

partnership; formerly Moderncare West

Seattle. 11/1/98 banked 21 beds; 8/23/00

approved to convert 21 beds back to SN use.

9/1/00 banked 21 beds. 2/11/02 unbank 5

beds. 4 beds converted from 9/1/00.3/16/03-

converted 5 BB.11 beds remaining banked

extended to 11/01/06-no further extensions.

Part of March 2007 Settlement - Modification

of 2 May 2007 - remain at 11 BB - Conv 11

beds BB08-24. 12/19/12 FFC BED BANKING 12/19/20

Life Care Center of Federal Way 1107 157 0 0 0 0 0 0 0 157

11/12/98 banked 18 beds; formerly Federal

Way Convalescent Center; 8/23/00 approved

to convert 18 beds back to SN use. 9/1/00

banked 18 beds.18 beds extended to

November 1, 2006. Part of March 2007

Settlement - Conv 18 beds BB08-23

Mercer Island Care and Rehabilitation

Center CLOSED 0 0 0 0 0 0 0 100 0

4/7/98 name chg-formerly Mercer Island Care

Ctr. 10/01/03-8 beds banked. Ext 8 beds 07-

48; BB exp of 8 beds 10-1-11. 5/1/13 CHOW

07/03/14 FACILITY CLOSED; 100 BEDS

BANKED UNDER FFC. See facility file b/c

both licensee & building owner banked beds.

See also M2015-1165 & King County judicial

review #16-2-21779-6 SEA 07/03/22

Mirabella 1501 46 0 0 0 0 0 0 0 46

11/14/06- CN 1341 approved 22 bed Type A

CCRC; facility opened December 2008; 5-

year transition ends December 2013.

02/14/14-CN #1524 issued to change from a

Type A CCRC NH to a community based

nursing home, with Seattle University as the

licensee. Facility to have a total of 46 beds

[phase 1=22; phase 2=24]. Phase 2

complete & license issued for 46 beds on

9/9/14. Formerly Mirabella-a type A CCRC

NH.

Mission Healthcare at Bellevue 1365 69 0 0 0 0 0 0 0 69

7/14/94 CN #1106 - replaces Bellevue Care

Center; licensee is Living Services, Inc.;

8/27/96 RA #011 - redist 59 beds from

Laurelwood Care Ctr; 3/1/97 merge floor 1&2;

3/01 name change formerly Eastside Medical

& Rehab. RA#088 reduces Mission

Healthcare at Bellevue's # of beds from 129

to 69.

printed 1/7/2020...12:11 PM 10 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Mission Healthcare at Renton 1584 60 0 0 0 0 0 0 0 60

RA #088 issued on 10/04/16 approves the

replacement of 60 beds from Mission

Healthcare at Bellevue to this new site in

Renton. RA#088 reduces Mission Healthcare

at Bellevue's # of beds from 129 to 69.

North Auburn Rehabilitation and Health

Center 1556 125 0 0 0 0 0 0 0 125

5/95 name change; formerly Green River

Terrace Nursing Center; 6/30/95 bank 12

beds; 7/1/96 bank 9 beds. 7/1/99 extend 12

beds originally banked on 7/1/95 to 7/1/03.

7/1/00 forfeit 9 beds (letter sent 6/15/00);

5/4/01 modify use of 12 beds.4/8/03-Forfeit 5

beds, ineligible usage. Converted BB. 7/1/15

CHOW. 12/01/17 CHOW.

Paramount Rehabilitation and Nursing 1540 165 0 0 0 0 0 0 0 165

CHOW 04/02/03-aka Branch Villa. 06/27/03-

Relinq 5 beds. 5/31/04-Relinq 32

beds06/01/04 35 beds banked. 12/01/04-

Relinquished all 35 beds 12/1/04. 09/26/16

CHOW-formerly Leon Sullivan Health Care

Center.

Park Ridge Care Center 1581 115 0 0 0 0 0 0 0 115

10/7/96 bank 13 beds; 10/16/98 CHOW-lost

13 banked beds.10/01/03-CHOW-Northwest

Care-Shoreline, Inc. 08/23/18 CHOW no

name change.

Park Shore 489 28 0 0 0 0 0 0 0 28

9/1/94 lost 4 beds - delic w/DSHS - DOH did

not rec. bed bank req. - RA#059 transfers 2

beds to The Terraces at Skyline - also

involves Exeter

Park West Care Center 1580 137 0 0 0 0 0 0 0 137

1/1/97 banked 13 beds; 10/16/98 CHOW-lost

13 banked beds. 10/01/03 CHOW- Northwest

Care-West Seattle.01/26/04 2 beds banked.

1/26/08-2 banked beds expired. 08/23/18


Providence Marianwood 1177 117 0 0 0 0 0 0 0 117

1/96 change of owner-Sisters of Providence;

1/16/97 name chg-formerly Marianwood -

Voluntary relinquishment of 3 beds 3/2012

Providence Mount St. Vincent Nursing

Center 77 215 0 0 0 0 0 0 0 215

CN #1096 issued 10/1/93 transferred 27 beds

to Providence Medical Center; Mt St Vincent

downsized by 37 beds; 11/95 antic completion

date. 8/2/99 - total of 215 SNF beds (Mt. St.

Vincent=173 & St. Joseph Residence=42).

2/17/00 RA #030 issued for renovation of Mt.

St. Vincent

Queen Anne Healthcare 1459 120 0 0 0 0 0 0 0 120

5/26/95 formerly Queen Anne Care Center;

6/26/95 bank 3 beds; 7/1/98 CHOW - forfeit 3

banked beds. 10/1/98 banked 41

beds.10/1/02-extended 35 beds, 5 lost Letter

cites 6); can't extend. - Loss of 35 beds

2/2007 with expiration - voluntary delicensing

of 10 beds 6-4-08. FORMERLY Queen Anne

Healthcare; FORMERLY Kindred Transitional

Care & Rehabilitation-Queen Anne.

FORMERLY Avamere Transitional Care and

Rehabilitation-Queen Anne

Redmond Care and Rehabilitation Center 1462 139 0 0 0 0 0 0 0 13912/01/13 CHOW-formerly Cascade Vista

Convalescent Center, Inc.

printed 1/7/2020...12:11 PM 11 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Advanced Post Acute 1544 96 0 0 0 0 0 0 0 96


partnership; 5/1/97 Name chg-formerly

Applegate Care Center - Chow Application 8-

1-06 to change - Formerly Life Care of Auburn

- New Licensee Regency Auburn as of

11/1/06; CHOW 03/01/17 formerly Regency

Auburn

Regency North Bend Rehabilitation and

Nursing Center 1431 64 0 0 0 0 0 0 0 64

7/1/95 bank 2 beds; 5/1/96 chg owner; name

chg-formerly North Bend Nsg Ctr; lost 2 beds

per CHOW. 5/1/98 banked 12 beds. 6/22/00

CN #1209 issued to add 10 beds to Forest

View from Mt. Si Transitional Health Center.

At project completion, Forest View = 70 & Mt.

Si = 76 licensed & 12 banked. 2/28/01

project authorized by CN #1209 complete. 12

Beds banked April 1, 200. Forfeited 12 beds

that expired on 5/1/02, also lost 6 beds for

non allowable AU. Convert 2 beds.

Conversion request (11/01/03) of 6 bb did not

take place=6 beds remain banked.6

remaining banked beds extend to 04/01/09-

cannot be extended further. 6 beds lost 4/09

with the expiration of BB. 04/15/15 name

change-formerly Mount Si Transitional Health

Center

Renton Nursing and Rehabilitation Center 1554 99 0 0 0 0 0 0 0 99

7/10/95 bank 17 beds, 11/1/98 bank 24 beds.

7/10/99 four year ext. appr. for 17 beds,

expire 7/10/03. 07/01/01 bank 20

beds.11/1/02-extend 19 of 24 beds, 5 lost,

can't extend. 17 beds banked 07/10/03

forfeited.03/01/05, CHOW, loss of 39 BB.

02/2013 name change formerly Regency at

Renton Rehab Center. 10/1/17 CHOW w/ no

name change

Richmond Beach Rehab 1346 140 0 0 0 0 0 0 0 140

4/7/98 name chg-formerly Richmond Beach

Med & Rehab Ctr. 6/01/99 name chg-formerly

Sunrise Care & Rehab for Richmond

Beach.7/1/03-CHOW from Sunbridge at

Richmond Beach.

Sea Mar Community Care Center 1161 48 0 0 0 0 0 0 0 48

7/1/96 banked 35 beds;12/1/97 convert 10

beds. 11/1/99 convert 2 beds; 1/13/00

convert 3 beds; 3/23/00 convert 6 beds;

3/23/00 4-yr extension on remaining 14 beds

to 7/1/04. March 22, 2001 convert 6 beds 8

beds remaining. 08/30/04 8 beds converted.

10/24/17 voluntarily relinquished 52 NH beds

with no bed banking.

Seattle Medical Post Acute Care 1228 103 0 0 0 0 0 0 0 103

7/1/95 bank 23 beds; 1/1/97 convert 23 beds;

5/1/97 name & owner chg-formerly Phoenix

Rehab; 2/1/98 bank 40 beds; 9/14/99 lost 40

banked beds due to change of ownership.

2/2013 name change formerly Seattle Medical

& Rehab Center

printed 1/7/2020...12:11 PM 12 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Shoreline Health and Rehabilitation 1526 114 0 0 0 0 0 0 0 114

3/31/95 voluntary reduction of 33 beds;

6/30/95 bank 17 beds convert date extend to

6/30/01 per Order - addtl 2 yr extend to

6/30/03. 10/1/98 banked 35 beds.5/1/02 13

BB.10/1/02-extended 35 banked beds.

Forfeited 17 banked beds from

6/30/95.Extend 13 beds banked 06/30/01to

06/30/09, cannot be extended. Loss of 1 bed

(room 109) and extended remaining 12

eligible. 9/30/06-35 AU beds expired & lost -

Conv of 12 beds BB09-22 (corrected letter)

name changed from Pinehurst Park Terrace.

10/01/15 CHOW name changed from

Shoreline Health & Rehabilitation Center.

Snoqualmie Valley Hospital N/A 0 0 25 0 0 0 0 0 0 8/31/09 increased swing beds from 5 to 25

Saint Anne Nursing and Rehabilitation

Center 1323 47 0 0 0 0 0 0 0 47

4/1/94 name change 9/1/01 CHOW - new

licensee St. Anne Corp; Formerly

Meadowbrook Nursing Home.

Stafford Healthcare 1364 165 0 0 0 0 0 0 0 165

2/14/00 banked 25 beds for AU. 12/17/03-

CHOW aka Seatoma, 25 Banked Beds

forfeited.02/02/04-New Licensee, Stafford

Healthcare, SeaTac, LLC,. 07/01/05

relinquished 75 beds.

Sunrise Haven 1315 8 0 0 0 0 0 0 0 8

10/6/97 voluntarily reduced license from 24 to

18; 10/6/99 voluntarily reduced license from

18 to 10; 1/10/01 voluntarily reduced license

from 10 to 8;

Talbot Center for Rehabilitation and

Healthcare 1573 136 0 0 0 0 0 0 0 136

6/1/97 name chg-formerly Renton Rehab &

Healthcare; 7/1/98 oper chg; 9/1/00 CHOW to

Evergreen at Talbot Road, LLC; 10/9/00 bank

31 beds.04/19/04 forfeited 4 beds, non

allowable under AU.08/03/04 1 bed

converted.10/01/04-final extension for

remaining 26 bb. Voluntary forfeiture of 26

banked beds in Oct, 2008. 05/14/18 CHOW

Terraces at Skyline (The) 1440 34 0 0 0 0 0 0 0 34

NH under construction - Tentative Name - RA

059 transfers 32 beds from Exeter (closing)

and 2 from Park Shore

The Kenney CLOSED 0 0 0 0 0 0 20 0 20

09/01/93 -18 beds to alt use (possibly

boarding home use); 01/01/95- 6 beds to alt

use (possible boarding home use); lost 18

beds, banking expired before dept rcvd req. to

convert; 1/28/98 unbank 6 beds. 02/21/18

closed & FFC bed banking 01/10/26

The Oaks at Forest Bay 1567 90 0 0 0 0 0 0 0 90

5/1/98 terminating MCaid contract; 7/1/98

oper chg. 2/1/99 forfeited 10 beds for not

meeting Medicaid standards, per DSHS letter

of 2/10/99. Formerly Arden Rehab and

Healthcare Center. 12/20/17 CHOW.

Formerly Kindred Nursing and Rehabilitation-

Arden

The Springs at Pacific Regent 1532 54 0 0 0 0 0 0 0 548/1/96 chg owner (Fountains Affiliated Co.s).

12/1/15 CHOW

Vashon Community Care Center CLOSED 0 0 0 0 0 0 0 30 0

6/26/95 banked 12 beds; formerly Island

Manor Nsg Ctr. 8/1/98 banked 3 beds.

CHOW forfeit 12 beds. 1/14/00 banked 3

more beds. 01/15/04, forfeited 6 banked

beds.

07/31/19 - FFC-BB effective date of closure

for 30 beds. 07/30/27

printed 1/7/2020...12:11 PM 13 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Washington Center for Comprehensive

Rehabilitation 1394 165 0 0 0 0 0 0 0 165

6/30/95 bank 10 beds; 2/7/96 banked 19

beds; 7/15/97 name chg-formerly Restorative

Care Center. 4/28/99 RA #021R issued for

replacement of Washington Center with a 179

bed SNF. 6/30/99 extension denied, lost 10

beds. 6/28/99 apprvd extension of 19 banked

beds to 2/7/04. 5/1/01 convert 19 beds back

to skilled use. 8/13/01 banked 14 beds. 14

beds banked 08/13/01 lost, none remaining.

New Licensee: Washington Care Services

Wesley Homes Health Center 1382 148 0 0 0 0 0 0 0 148

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR KING 5,410 106 30 9 0 4 537 130 5,960

Bainbridge Island Health and

Rehabilitation Center 1510 69 0 0 0 0 0 0 0 69

6/30/95 bank 6 beds; 12/95 formerly Winslow

Convalescent Center; 7/1/96 banked 3

beds;7/1/97 bank 5 beds. Extended 6 beds

banked on 7/1/95 to 7/1/2003 (these bed

cannot be extended for another 4 years).

8/1/99 banked 10 beds. 8/1/00 3 beds

forfeited (letter sent 6/21/00); Reminder

mailed 1/18/01 for 5 beds banked 7/1/97;

3/29/01 extended 5 beds banked on 7/1/97 to

7/1/2005. 07/14/01 banked 2 beds.5/1/02-

converted 6 beds.4/8/03 2 BB. 8/1/03 last

extension for 10BB. 7/1/03-relinquish 1BB.

05/24/05 convert 4 beds. Extend 2 beds

banked on 07/14/01 to 07/14/09-can't extend -

Asked to ext 3 (BB07-18), extended 2 -

differed 1 back to them - Converted 19

March, 2007 Awaiting ALM - ALM received

for 88 - immediately relinquished 19 bed count

remains at 69. 05/01/15 CHOW formerly

lsland Health and Rehabilitation Center

Bremerton Convalescent and


11/94 change of owner; 6/30/95 bank 6 beds;

7/1/96 banked 7 beds. 7/1/99 extend 6

banked beds of 6/30/95 to 6/30/03. 8/1/99-

3BB. 7/1/00 forfeit 7 beds (letter sent

6/15/00). 8/29/01 Name change, now

Bremerton Health 7 Rehab. 8/1/03, extend

beds banked 8/1/99.07/18/03 3 beds

relinquished, 3 beds converted.11/02/04 3

beds converted, no beds remain banked.

7/1/15 CHOW-formerly Bremerton Health &

Rehabilitation Center. 12/01/17 CHOW

Forest Ridge Health and Rehabilitation

Center 1560 98 0 0 0 0 0 0 0 98

11/94 Change of owner; 3/1/97 name chg;

8/1/97 bank 15 beds; 9/11/00 convert 7 beds

; 8 remain banked; reminder mailed 1/18/01

for 8 beds. 3/29/01 extended 8 beds banked

on 7/1/97; new expn is 7/1 05 (these beds

cannot be extended for another 4

years.)10/21/03-2 beds converted. 12/29/04 4

beds converted, 2 remain banked. 05/18/05 2

beds converted. 7/1/15 CHOW. 12/01/17

CHOW.

Life Care Center of Port Orchard 1418 125 0 0 0 0 0 0 0 1256/1/96 Life Care Centers purchased as limited

partnership; name change

Martha and Mary Health Services 1216 190 0 0 0 0 0 0 0 190

printed 1/7/2020...12:11 PM 14 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Messenger House Care Center CLOSED 0 0 0 0 0 0 96 0 96

05/31/18 Closed; 06/12/18 sent letter

informing of FFC bed banking. 07/06/18 FFC

beds banking-96 beds 06/01/26

Northwoods Lodge 1589 57 0 0 0 0 0 0 0 57

3/4/94 bank 13 beds; 7/1/94 Medicaid cert.

3/24/96 reinstated 6 banked beds; 9/26/97

granted 4 yr bank ext.-expire 3/4/02. 1/7/99

convert 3 beds back. Forfeited banked beds.

03/01/17 CHOW. 11/28/18 CN1753 approve

the unbanking of 10 banked beds and

addition to capacity

Stafford Healthcare at Belmont 575 102 0 0 0 0 0 0 0 102 Name changed formerly Belmont Terrace

Stafford Healthcare at Ridgemont 588 96 0 0 0 0 0 0 0 96

8/15/96 banked 5 beds; 6/21/00 4 year extn

on 5 beds to 8/15/2004. 8/15/2004-45 beds

forfeited, no banked beds. Name changed

formerly Ridgemont Terrace

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR KITSAP 793 0 0 0 0 0 96 0 889

Kittitas Valley Community Hospital N/A 0 0 5 0 0 0 0 0 0

Prestige Post-Acute and Rehabilitation

Center-Kittitas 1468 74 0 0 0 0 0 0 0 74

7/26/95 formerly WHC-Gold Leaf; 10/1/95

formerly Kittitas Valley Regional Rehabilitation

Center; 7/1/96 banked 6 beds; 7/1/00 forfeit 6

beds (letter sent 6/15/00). 09/22/14 CHOW

formerly Kittitas Valley Health & Rehabilitation

Center.

Royal Vista Nursing & Rehab 1344 0 0 0 0 0 0 67 0 67

7/1/95 bank 4 beds. 7/1/99 extension request

denied, lost 4 beds.5/1/03 CHOW. 06-59 -

banked 15. Ext of 15 BB10-03 - Voluntary

Relinqishment of 15 beds 6/2010. 08/20/15

FFC bed banking for 67 beds [BB16-01] 08/20/23

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR KITTITAS 74 0 5 0 0 0 67 0 141

Klickitat Valley Hospital N/A 0 0 25 0 0 0 0 0 01/6/10 increased swing beds from 5 to 15;

8/2/10 increased swing beds from 15 to 25.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR KLICKITAT 0 0 25 0 0 0 0 0 0

Prestige Post-Acute and Rehabilitation

Center-Centralia 1469 128 0 0 0 0 0 0 0 128

1/1/94 name change; 9/1/13 CHOW.

09/01/14 CHOW formerly Liberty Country

Place. 4/1/15 name change-formerly Prestige

Post-Acute and Rehabilitation Center-Liberty

printed 1/7/2020...12:11 PM 15 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Riverside Nursing and Rehabilitation

Center 1559 91 0 0 0 0 0 0 0 91

06/29/94 banked 10 beds; 6/30/95 bank 18

beds; 7/1/96 banked 14 beds; 7/1/97 bank 6

beds; 6/29/98 extend banking of 10 beds

originally banked on 6/29/94 to 6/29/02 (these

10 beds cannot be extended another 4

years). 7/1/99 extend banking of 18 beds

originally banked on 7/1/95 to 7/1/03 (these

18 beds cannot be extended another 4

years). 7/1/00 forfeit 14 beds (letter sent

6/15/00); reminder mailed 1/18/01 for 6 beds

banked 7/1/97; 3/29/01 extended banking for

6 beds banked 7/1/97 to 7/1/05 (these 6 beds

cannot be extended another 4 years).

07/14/01 banked 3 beds. 08/01/01 banked 5

beds. Forfeited 10 beds banked 6/29/94.

Relinquished 10 beds expiring on 6/29/02.

Converted 8 BB. 14 beds remain banked

04/21/04 6 beds converted, 8 beds remain

banked. Relinquished 6 beds banked

07/01/97, 2 remain banked. 2 beds banked

expire on 08/01/09 - 2 beds conv 4/09.

12/01/17 CHOW.

Sharon Care Center 1304 42 0 0 0 0 0 0 0 427/1/00 CHOW (additional corporate owners

added)

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR LEWIS 261 0 0 0 0 0 0 0 261

Lincoln Hospital CLOSED 0 0 5 0 0 0 35 0 35

Banked 3 beds 3/3/00.Loss of 3 banked

beds. 05/23/12 banked 35 SNF beds under

FFC. 05/23/20

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR LINCOLN 0 0 5 0 0 0 35 0 35

Fir Lane Health and Rehabilitation Center 1564 135 0 0 0 0 0 0 0 135

formerly Fir Lane Terrace Convalescent

Center; 8/1/99 banked 9 beds. 7/14/01-15

BB, Extend beds banked 8/1/99 to 8/1/07 (no

extension poss).01/20/04 1 banked bed

forfeit, not AU purpose. 03/04/05-Loss of 6

banked beds per DSHS survey findings-17

beds remain banked. Extend 14 beds banked

07/12/01 to 07/12/09=not able to extend. 17

banked beds relinquished as part of approval

of CN07-04. 7/1/15 CHOW. 12/01/17

CHOW.

Shelton Health and Rehabilitation Center 1324 76 0 0 0 0 0 0 0 76

2/1/99 name chg-formerly Exceptional

Foresters Care Center 9/1/01 CHOW and

name change. Formerly Sunbridge Care &

Rehab for Shelton

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR MASON 211 0 0 0 0 0 0 0 211

North Valley Hospital N/A 42 0 5 0 0 0 0 0 42

8/28/00 approval for 5 swing beds. 04/18/05-

relinquish 18 beds-request rescinded. 11/2/06

banked 10 and relinquished 2- relinqushed

remaining 10 BB 6/1/2010. 09/24/14

reliquished 16 beds [from 58 to 42]

printed 1/7/2020...12:11 PM 16 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Okanogan County PHD #3-Mid-Valley

Hospital N/A 0 0 5 0 0 0 0 0 04/19/85 approval for 5 swing beds

Regency Harmony House Rehabilitation

and Nursing Center 1536 54 0 0 0 0 0 0 0 54

6/30/95 banked 5 beds. 10/21/98 banked 3

beds; 10/1/99 extend 5 beds to 10/1/03;

5/15/00 bank 8 beds and relinquish rights to 3

beds; 12/20/00 RA #033 issued for the

renovation of Harmony House; at time of

issuance, 54 licensed beds and 16 banked

beds. 11/01/01 unbank 6 beds. 2/1/02

banked 6 beds AU. Forfeited 8 beds banked

from 6/30/95, 10/01/98. 8 beds remaining

banked. 05/01/04 Forfeiture of 2 banked beds-

6 beds remaining. 02/01/05, loss of all 6

banked beds. 06/01/16 CHOW formerly

Harmony House Health Care

Regency Omak 1479 56 0 0 0 0 0 0 0 56

7/1/95 bank 2 beds, 10/1/98 bank 8 beds.

5/31/99 convert 10 beds. CHOW. 7/1/99

banked 27 beds. 4/1/01 banked 12 beds.

Forfeited 27 beds banked on 7/1/99. 04/01/05-

12 beds banked on 04/01/01 extended-cannot

be extended again. Loss of 12 beds 2/09 due

to missed conv application - Settlement

replaced 6 of 12 lost beds 5/1/10. RA #070

issued to replace Valley Care Center at a new

site in Omak. CHOW 11/01/14 formerly

Valley Care Center.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR OKANOGAN 152 0 10 0 0 0 0 0 152

Ocean Beach Hospital N/A 0 0 15 0 0 0 0 0 0

Willapa Harbor Health & Rehab 1357 60 0 0 0 0 0 0 0 60

12/1/03 CHOW-Avalon Care Center

Raymond - Banked 20 beds 3/09 BB09-13 -

voluntary relinq of 20 beds 9/29/10. 7/1/12

name change from Willapa Harbor Care

Center

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR PACIFIC 60 0 0 0 0 0 0 0 60

Newport Community Hospital N/A 0 0 24 0 0 0 0 0 0

8/25/98 CN #1181 issued for post renovation

project. 05/30/14 increase swing beds from 5

to 24 [DOR14-25]. 08/01/19 Hospital closed

its 50 bed TCU and did not bank the beds

under FFC. 24 swing beds at CAH.

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR PEND OREILLE 0 0 24 0 0 0 0 0 0

Alaska Gardens Health and Rehabilitation

Center 1397 123 0 0 0 0 0 0 0 123

2/1/97 Franciscan Eldercare forming new

corp; 2/1/97 name chg-formerly Franciscan

HCC at Tacoma CHOW 8-1-06 new operator -

Evergreen at Tacoma LLC previously

Franciscan Health Care at Tacoma - Formerly

Tacoma Health & Rehab Center

printed 1/7/2020...12:11 PM 17 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Avamere at Pacific Ridge 1405 102 0 0 0 0 0 0 0 102

7/1/98 oper & name chg-formerly Tacoma

Terrace. 11/1/98 37 beds banked. 7/1/99

unbanked 37 beds. 12/15//00 bank 42 beds.

Extend 33, 9 beds forfeited=Per 05/14/04

Settlement Agreement: 38 beds extended,

5 forfeited with adjusted expiration date

03/28/03. Conv 08-10 of 40 beds effective

3/14/08 - Voluntary relinquish of 30 beds 4-1-

08 Formerly Tacoma Rehab - ext 10-06 of 3

remaining banked beds. Voluntary

relinqushment of 3 beds 8/2010. 01/01/15-

NAME CHANGE Formerly Avamere Skilled

Nursing of Tacoma.

Avamere Heritage Rehabilitation of

Tacoma 1403 89 0 0 0 0 0 0 0 89

7/1/98 oper chg; 7/24/98 name chg; 3/23/00

banked 19 beds. 05/03/01 unbanked 4 beds.

Extended 15 beds to12/15/07 (corrected date,

banked on 12/15/99) - Converted 15 BB-08-

01 RA #058 issued on 07/14/06 approving

renovation of the NH. 02/20/08 RA #058 was

relinquished without completion of the

renovations.

Avamere Transitional Care of Puget

Sound 1542 60 0 0 0 0 0 0 0 60

7/1/98 oper chg; Formerly Georgian House.

RA #080 issued on 12/12/14 approving

replacment facility. (Formerly Avamere

Georgian House of Lakewood) New name:

Avamere Transitional Care of Puget Sound.

With completion of RA #080A2 relinquished

13 beds; current license is 60.

Cottesmore of Life Care 1368 108 0 0 0 0 0 0 0 108

5/1/96 chng owner;12/6/96

Medicare/Medicaid certified per CHOW.

01/11/16 RA #084 issued for renovation;

10/07/16 RA #084R issued to correct error in

RA #084.

Franke Tobey Jones 452 43 0 0 0 0 0 0 0 43

Heartwood Extended Health Care 1308 120 0 0 0 0 0 0 0 120 8/1/00 CHOW;

Heron's Key [Type A CCRC] 1555 0 45 0 0 0 0 0 0 0 Type A CCRC nursing home

Life Care Center of Puyallup 1387 102 0 0 0 0 0 0 0 102

1/96 change owner; 11/1/98 banked 52 beds;

12/10/99 RA #028 issued for renovation of

Valley Terrace Nursing Center. name chg-

formerly Valley Terrace Nursing Center;

8/23/00 approved to convert 52 beds back to

SN use. 9/1/01 banked 52 beds. 10/01/01

banked 10 beds. Extend 52 beds expire

11/01/06-no extension. 10 beds banked

10/01/01 forfeited, notification not timely. Part

of March 2007 Settlement - BB08-21 conv 50

beds - BB09-09 Conv 3 beds - CBB09-27

CONV 9 BEDS. RA #075 issued for a new

facility in Puyallup using 100 of the 202

licensed beds. Project completion Life Care

Puyallup 102 beds; Life Care South Hill-100

beds.

Life Care Center of South Hill 1533 100 0 0 0 0 0 0 0 100 See RA #075

Linden Grove Health Care Center 1529 130 0 0 0 0 0 0 0 130

7/1/98 oper chg. 12/1/15 CHOW. Name

change: formerly Linden Grove Care Center

Manor Care Health Services (Gig Harbor) 1592 120 0 0 0 0 0 0 0 12011/1/95 CHOW; 1/21/07 CHOW; 08/05/18

CHOW. 01/01/20 CHOW

printed 1/7/2020...12:11 PM 18 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Manor Care Health Services (Tacoma) 1597 124 0 0 0 0 0 0 0 124

9/3/96 name chg-formerly Manor Care of

Meadow Park; 7/1/97 bank 1 bed; reminder

mailed 1/18/01; 4/5/01 4 year extension for 1

bed granted to 7/1/2005. Loss of bed banked

07/01/97. CHOW 12-21-07; 08/05/18

CHOW. 01/01/20 CHOW

Nisqually Valley Care Center CLOSED 0 0 0 0 0 0 63 0 63

05/22/18 Closed; 06/12/18 sent letter

informing of FFC bed banking. 07/06/18 FFC

beds banking-63 beds 05/23/26

Orchard Park Health and Rehabilitation

Center 1531 147 0 0 0 0 0 0 0 147

CN #1083 - 6/23/98 VOID-lost CN result of

CHOW; 7/1/98 oper chg. 6/9/15 name

change-formerly Orchard Park. 12/1/15

CHOW

Park Rose Care Center 1424 139 0 0 0 0 0 0 0 139

10/14/96 bank 12 beds; 10/16/98 CHOW-lost

12 banked beds; 9/13/00 approved to bank

44 beds on C wing. 5/1/03, additional 23

beds banked.44 beds extended to 8/8/08, no

extension for these. 4/1/07 23 beds expired &

lost. 8/8/08-44 beds expired & lost. [Loss of

67 beds (44+23)]

Puyallup Nursing and Rehabilitation

Center 1434 96 0 0 0 0 0 0 0 96

7/10/95 bank 26 beds. 11/1/98 bank 13 beds.

7/1/99 bed bank extension - 26 beds to

7/10/03. 7/1/01 banked 3 beds.11/1/02-

extend 13 beds, can't extend. 26beds banked

7/10/95 forfeited. 03/01/05-CHOW, loss of 13

BB. 02/2013 name change [formerly Regency

at Puyallup Rehabilitation Center]

Rainier Rehabilitation 1467 117 0 0 0 0 0 0 0 117

7/1/98 oper chg. Formerly Rainier Vista Care

Center Delicensed 3 beds 7/2010. 06/01/14

CHOW & name change-formerly Kindred

Transitional Care & Rehab-Rainier Vista

Rocky Bay Health Care Facility 822 30 0 0 0 0 0 0 0 30

Tacoma Lutheran Retirement Community 601 187 0 0 0 0 0 0 0 187

1/1/00 banked 31 beds. Forfeited 9 beds,

remaining 25 extended under AU. 03/01/04 2

BB, expire 03/01/08. 3/2008-Loss of 27(25+2)

expired banked beds . 11/01/17 name change-

formerly Tacoma Luther Home.

Tacoma Nursing and Rehabilitation

Center 1586 150 0 0 0 0 0 0 0 150

7/10/95 bank 17 beds. 11/1/98 bank 30 beds;

4/13/00 CHOW lost 47 beds. 7/11/01-3 beds

banked, total bed banking. 03/01/05, CHOW,

loss of 3 BB. 02/2013 name change [formerly

Regency at Tacoma Rehab Center]. 1/1/19


The Oaks at Lakewood 1568 80 0 0 0 0 0 0 0 80

7/1/98 oper chg. Formerly Lakewood

Healthcare Center. 12/20/17 CHOW.

Formerly Kindred Transitional Care and

Rehabilitation-Lakewood

University Place Rehabilitation Center 1553 120 0 0 0 0 0 0 0 12010/1/17 CHOW; formerly University Place

Care Center

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR PIERCE 2,287 45 0 0 0 0 63 0 2,350

printed 1/7/2020...12:11 PM 19 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Life Care Center of The San Juan Islands CLOSED 0 0 0 0 0 0 85 0 85

7/1/95 bank 5 beds; 6/1/97 convert 5 beds;

9/1/97 CHOW-Cascade Medical Investors;

1/1/98 bank 20 beds; 10/30/98 banked 5

beds; 8/23/00 approved to convert 25 beds

back to SN use. 9/1/00 banked 25 beds.

10/01/01-5 beds banked. 12/10/02-Convert 5

beds.5/4/03-4 BB Converted. Extend 20 beds

to 01/01/06. Part of March 2007 Settlement -

Mod of 3 beds May 2007 07-38 - Conv 21

beds BB08-22. Formerly Islands

Convalescent Center; formerly Life Care

Center of San Juan. 11/01/25

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR SAN JUAN 0 0 0 0 0 0 85 0 85

Life Care Center of Mount Vernon 1393 121 0 0 0 0 0 0 0 121

12/1/95 change owner, purchased by Mount

Vernon Medical Investors Limited

Partnership; Formerly Mount Vernon Care

Center; 5/1/96 bank 16 beds; 5/1/00 extend

16 beds (letter sent 2/29/00); 8/23/00

approved to convert 16 beds back to SN use.

9/1/00 banked 22 beds. Name chg - formerly

Mt. Vernon Care Center. Extend 22 beds,

expire 09/01/08-no further extension. Part of

March 2007 Settlement - Conv 08-25 of 22

beds

Life Care Center of Skagit Valley 1388 150 0 0 0 0 0 0 0 150

1/96 change owner; 11/12/98 banked 8 beds;

formerly Skagit Valley Convalescent Center,

Inc. 8/23/00 approved to convert 8 beds back

to SN use. 9/1/01 banked 8 beds. 11/1/2001

banked 12 beds Alt Use. 08/01/02-10 beds .

banked. Extend 11 beds banked 09/01/04, 26

months remaining to 11/01/2006. 12 beds

banked 11/01/01 forfeited, untimely request,

18 beds remaining. Part of March 2007

Settlement BB08-20 conv 8 beds - BB09-28

Conv 12 beds. 4/2010 converted remaing 10

banked beds

Mira Vista Care Center 1524 94 0 0 0 0 0 0 0 94

RA #027, add 30 beds from Mira Vista at

United. 7/1/15 CHOW but no name change.

Prestige Care and Rehabilitation-

Burlington 1451 49 0 0 0 0 0 0 0 49

4/7/98 name chg-formerly Burton Care Ctr.

6/1/99 name chg-formerly Sunrise Care &

Rehab for Burlington. 12/1/99 CHOW,

purchased by Eagle Healthcare & changed

name back to Burton Care Center. CHOW

10/01/12 formerly Burton Care Center

San Juan Rehabilitation and Care Center 1546 0 0 0 0 0 0 0 26 0

4/7/98 name chg-formerly San Juan Care Ctr.

6/1/99 name chg-formerly Sunrise Care &

Rehab for Anacortes. 12/1/99 CHOW now

Eagle Healthcare (owning entity) - RA#052

Expired. 07/01/17 CHOW w/ no name

change. 08/22/17 FACILITY CLOSED.

Banked 26 of 52 beds under FFC. 08/22/25

printed 1/7/2020...12:11 PM 20 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Soundview Rehabilitation and Health

Care Center 1590 44 0 0 0 0 0 0 0 44

7/1/95 bank 42 beds; 5/21/98 RA #017 issued

for the remodel of Anacortes Convalescent

Center; 6/1/98 forfeit 21 licensed beds;

7/15/98 forfeit 12 licensed beds; 10/1/98

name chg-formerly Anacortes Conv Ctr;

7/1/99 forfeit 42 beds. 01/01/05-Name

Change Only: was Alliance Living Community

of Anacortes. 12/03/19 CHOW & name

change; formerly Fidalgo Care Center.

United General Hospital N/A 0 0 5 0 0 0 0 0 0

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR SKAGIT 458 0 5 0 0 0 0 26 458

Aldercrest Health and Rehabilitation

Center 1557 128 0 0 0 0 0 0 0 128

2/95 name changed from Washington

Healthcare Center-Aldercrest; 7/1/96 banked

32 beds; 8/1/99 banked 12 beds. 7/1/00

forfeit 32 beds (letter sent 6/15/00).Extend 12

beds banked on 8/1/99 to 8/1/07(no

extension).8/1/03 extended 12 BB to 8/1/07.

05/18/05 8 beds converted, 4 remain banked -

modified banked beds 3-22-06 - Converted 4

beds 07-44. 7/1/15 CHOW. 12/01/17 CHOW

Arlington Health and Rehabilitation 1334 76 0 0 0 0 0 0 0 76

5/1/96 chg owner. 04/01/14 relinquished 20

beds. 4/1/14 name change-formerly Regency

Care Center at Arlington.

Bethany at Pacific 1290 111 0 0 0 0 0 0 0 111

15 beds banked 11/05/93; CN #1089A appvd

31 beds for TCU (Bethany Transitional Care);

vol. gave up 5 beds; max. beds for NH is 101.

Name chg, was Bethany on Broadway.

6/2/00 CN #1207 issued to add 10 beds for a

total of 111 beds. Project complete 6/27/00

Bethany at Silver Lake 1049 120 0 0 0 0 0 0 0 120

Bothell Health Care 1439 99 0 0 0 0 0 0 0 99Formerly Life Care Center of Bothell, CHOW

8/2010

Delta Rehabilitation Center 545 125 0 0 0 0 0 0 0 125 7/13/07-voluntarily relinquished 12 beds.

Everett Center 1505 100 0 0 0 0 0 0 0 100

4/7/98 name chg-formerly Everett Rehab Med

Ctr. 6/1/99 name chg-formerly Sunrise Care &

Rehab for Everett. 7/1/00 name chg-formerly

Sunbridge Care & Rehab for Everett.

03/01/14 name change-formerly Everett Care

and Rehabilitation Center. 01/23/15 CHOW

Everett Transitional Care Services 1245 0 0 0 0 0 0 31 0 31

CN #1089A appvd 31 beds for TCU (Bethany

Transitional Care); max. beds for TCU is 50;

4/1/98 Bethany of NW and Prov. Hosp form

50-50 partnership; 6/1/98 name/oper chg-

formerly Bethany TCU. 03/25/19 FFC bed

banking for 31 beds. 03/14/27

Josephine Caring Community 143 160 0 0 0 0 0 0 0 16001/01/18 name change. Formerly Josephine

Sunset Home.

printed 1/7/2020...12:11 PM 21 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Lynnwood Post Acute Rehabilitation

Center 1478 67 0 0 0 0 0 0 0 67

2/1/00 banked 14 beds. 02/02/04, 14 beds

forfeited.02/01/05-Receivership, new licensee

Symmetry Long Term Care Group, LLC.

CHOW 5/1/06 from Lynnwood Manor Health

Care New Licensee: Lynnwood Health

Services. BB10-01 banking of 28 beds by

new owners - relinquished 15 of 28 beds on

06/01/10 [13 beds remain banked]. Name

change 12/2010. 06/2011 request to convert

13 banked beds, but failed to proceed with

conversion of 13 beds. 13 Beds remain

banked until 07/01/13. 07/15/13 - failed to

request to unbank 13 beds-13 banked beds

are relinquished. Zero beds remain banked.

09/03/14 CHOW for licensing. 06/01/17 name

change-formerly Emerald Hills Rehabilitation

and Skilled Nursing.

Manor Care Health Services (Lynnwood) 1593 113 0 0 0 0 0 0 0 113

9/3/96 name chg (formerly Manor Care Nsg &

Rehab Ctr) CHOW 12-21-07; 08/05/18

CHOW. 01/01/20 CHOW

Marysville Care Center 1534 97 0 0 0 0 0 0 0 976/1/96 Life Care Centers purchased as limited

partnership. 02/01/16 CHOW

Mountain View Rehabilitation and Care

Center 1463 82 0 0 0 0 0 0 0 82

11/94 formerly Madeleine Villa Conv. Ctr;

12/31/96 bank 16 beds/10/21/98 banked 4

beds. 8/23/00 extend 16 beds to 12/31/04.

Lost 4 beds banked on 10/21/98, 16 remain

banked. 10/24/04 convert 10 beds, bank 10 -

other.07/07/05 loss of 2 beds, relinquished

4=10 remain banked. Ext of 10 beds BB-09-

03- Mod 09-18 to rectify count and use in

room 28 - Banked 6 more beds for remainder

of ext period 5/2010. 10/25/12 lost 16 beds

banked under AU. 12/01/13 CHOW & new

name [formerly Madeleine Villa Care Center]

Prestige Care and Rehabilitation of

Edmonds [This is the FFC closed

facility w/ 9 FFC beds banked

remaining] CLOSED 0 0 0 0 0 0 9 0 9

7/1/98 oper chg. 3/1/02-5 beds banked.

02/12/04-4 beds banked. Banking extended

to 2010. Subsequent sale of facility in 2008

led to acknowledged loss of 9 banked beds.

05/08/13 FFB bed banking for 89 beds

expires 5/8/2021. 06/23/14 CN #1529 issued

for 80 of the 89 beds. 9 beds remain banked

under FFC. 05/08/21

Prestige Post-Acute and Rehab Center-

Edmonds 1528 80 0 0 0 0 0 0 0 80

CN #1529 issued on 06/23/14 approving the

estabilshment of an 80-bed nusring home

using 80 of the 89 FFC beds banked at

Prestige Care and Rehabilitation of Edmonds.

12/1/15 License issued. M/M facility

Providence Hospital N/A 12 0 0 0 0 0 0 0 12merge w/Bethany trans care - Everett

transitional care services 4112454

Regency Care Center at Monroe 1425 92 0 0 0 0 0 0 0 92 5/1/96 chg owner

Snohomish Health and Rehabilitation 1474 91 0 0 0 0 0 0 0 91

01/01/05 New Licensee: Merry Haven Care

Center, LLC. 09/01/14 CHOW formerly Merry

Haven Care Center

Sunrise View Convalescent Center 1166 59 0 0 0 0 0 0 0 59

7/1/95 change ownership; 1/9/98 bank 5

beds. 5 BB extended, expire 1/9/06 - 5 beds

lost 2/2007 with expiration

printed 1/7/2020...12:11 PM 22 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

View Ridge Care Center 1550 70 0 0 0 0 0 0 0 70

6/01/94 changed name; 4/16/96 RA#008

complete 2/98; 6/22/00 CN #1209 issued to

add 10 beds from Mt. Si Transitional Health

Center. At project completion, Forest View =

70 & Mt. Si = 76 licensed & 12 banked.

2/28/01 project authorized by CN #1209

complete. 2016 name change-formerly Forest

View Transitional Health Center. 08/01/17

CHOW & name change; formerly Regency

Everett Rehabilitation and Nursing Center.

Warm Beach Health Care Center 645 59 0 0 0 0 0 0 0 59

08/3/15 NH reliquished 15 beds [from 81 to

66] 10/17/16 NH relinquished 7 beds [from 66

to 59]

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR SNOHOMISH 1,741 0 0 0 0 0 40 0 1,781

Alderwood Manor 1102 85 0 0 0 0 0 0 0 85

Avalon Care Center at Northpointe 1358 119 0 0 0 0 0 0 0 119

CN #1111 - replacement facility of Lilac City &

Mansion House both of Spokane County.

12/17/03 CHOW aka Beverly Health & Rehab

at Northpointe.

Cheney Care Center 732 54 0 0 0 0 0 0 0 54

09/01/04 10 Bed banked, expire

09/01/08.04/01/05 conversion of 2 beds, 8

remain banked - BB08-31 ext of 8 BB.

Voluntary relq. Of 8 banked beds 11/2010

Franklin Hills Health and Rehabilitation

Center 1565 100 0 0 0 0 0 0 0 100

11/94 formerly Northcrest; 6/30/95 bank 7

beds; 7/1/96 banked 4 beds; 7/1/97 bank 5

beds; 10/24/97 bank 39 beds. 7/1/99 extend 7

beds banked on 7/1/95 to 7/1/03 (these 7

beds cannot be extended for another 4

years). 8/1/99 banked 4 beds. 7/1/00 forfeit 4

beds (letter sent 6/15/00); 3/29/01 extend 5

beds banked on 7/1/97 (these 5 beds cannot

be extended another 4 years). 7/13/01 extend

39 beds banked 10/24/97 (these 39 beds

cannot be extended another 4 years). Extend

4bb from 8/1/99, expire 8/1/07 (no extension).

Relinquish 7 beds banked on 7/1/03.

04/08/05 Loss of 5 BB from 7/1/97, no app

received, just a request to extend the period-

Jan responded. Relinquished 3 beds in room

15 effective 10/24/05.08/21/05 23 beds

converted. **Confirmation received on RA of

23 beds to Gardens on Univ. 6-23-06 - 21 of

121 beds relinquished with approval of CN07-

04. 7/1/15 CHOW. 12/01/17 CHOW.

Good Samaritan Society-Spokane Valley 1585 97 0 0 0 0 0 0 0 97

9/27/94 bank 31 beds - lost 7 beds-delic prior

to bnk appvl; '7/1/95 formerly Spokane Valley

Good Samaritan Center; 3/6/98 voluntarily

relinquish 30 banked beds used for assisted

living-see BB file; 11/1/99 relinquished 37

licensed beds & 1banked bed (total

38).11/01/01 banked 29 beds 9/21/2005. All

29 beds relinquished. Formerly Spokane

Valley Good Samaritan Village. 1/1/19 CHOW

no name change.

printed 1/7/2020...12:11 PM 23 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Manor Care Health Services (Spokane) 1596 125 0 0 0 0 0 0 0 125

9/3/96 name chg (formerly Manor Care Conv

& Rehab CHOW 12-21-2007; 08/05/18

CHOW. 01/01/20 CHOW

North Central Care Center 1571 99 0 0 0 0 0 0 0 99

7/1/94 change in operator; 01/01/13 relinquish

2 beds [from 101 to 99]. 1/11/18 CHOW &

name change-formerly North Central Care

and Rehabilitation

Providence St. Joseph Care Center 1417 113 0 0 0 49 0 0 0 162


per CHOW 1/1/97combine operations w/St.

Joseph Care Center (formerly St. Brendan)-

same owner/licensee; 10/1/00 4 year

extension on 15 beds (letter sent 6/21/00);

loss of 15 beds - 5/4/01 banked 17 beds - 1-

29-07 approved to unbank 17 beds in lieu of

expansion to be done by Jan 30, 2008.

06/08/16 RA #087 issued for renovation.

05/11/18 AU bed banking 05/11/22

Regency at Northpointe 1432 120 0 0 0 0 0 0 0 120

7/10/95 bank 14 beds-lost 1 bed-delic.

w/DSHS prior to DOH appvl; 11/20/95

RA#003-facility to be replaced, will not bring

14 beds back on line (see 1995 NH

determinations file); formerly Regency Care

Center of Spokane; After completion of

RA#003 120 bed facility

Riverview Lutheran Retirement

Community of Spokane 544 75 0 0 0 0 0 0 0 75

01/01/16 name changed-formerly Riverview

Lutheran Care Center. 04/21/16 formerly

Riverview Care Center.

Rockwood at Hawthorne 1283 20 0 0 0 0 0 0 0 20

1/5/96 RA#002; name chg-formerly

Hawthorne Manor Retirement Residence; RA

#002 expired 1/5/98; 2/1/00 name chg-

formerly Hawthorne Retirement Community

Health Care.

Rockwood South Hill 457 0 45 0 0 0 0 0 0 0

Type A CCRC nursing home. 10/4/96 name

chg-formerly Rockwood Manor Infirmary -

5/09 formerly Rockwood Retirement Commun

Hlth Ctr

Royal Park Health and Rehabilitation 1471 164 0 0 0 0 0 0 0 1649/1/14 CHOW formerly Royal Park Care

Center

Sullivan Park Care Center 1345 125 0 0 0 0 0 0 0 1255/1/03 CHOW - Relinquished 2 beds in PT

remodel - DSHS reinstated 2 beds 8/08

Sunshine Health & Rehab 1050 84 0 0 0 0 0 0 0 848/15/96 RA #010. 01/18/19 name change-

formerly Sunshine Gardens

The Gardens on University 1566 124 0 0 0 0 0 0 0 124

5/23/94 bank 10 beds; 8/1/94 chg of

oper./name chg-formerly Unicrest Nsg &

Rehab Ctr; 3/1/95 name chg from The

Gardens; 6/30/95 bank 14 beds; 4/1/98

convert 2 beds. Extended 10 beds banked

5/23/94 to 5/23/02. Extended 12 beds banked

on 6/30/95 to 7/1/2003.Relinq 10 beds,

forfeited 12 beds.12/22/03-Reconsideration of

12 forfeited beds, relinquish 4 convert 8,

effective 01/01/04. **Confirmation received on

RA of 23 beds from Franklin Hills 6-23-06.

7/1/15 CHOW. 12/01/17 CHOW.

Touchmark on South Hill 1201 57 0 0 0 0 0 0 0 57CN#976;online 5/30/96 - CHOW in 6/2011

formerly Waterford on South Hill Rehab

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR SPOKANE 1,561 45 0 0 49 0 0 0 1,610

Buena Vista Healthcare 1502 40 0 0 0 0 0 0 0 406/11/98 oper chg. 2/1/15 CHOW-formerly

Buena Vista Inc

printed 1/7/2020...12:11 PM 24 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Mount Carmel Hospital N/A 5 0 4/25/02-5 swing beds

Prestige Care & Rehabilitation-Pinewood

Terrace 1457 92 0 0 0 0 0 0 0 92

6/30/95 bank 1 bed. 7/1/99 extension denied,

lost 1 bed. 7/22/99 CHOW to Beverly

Healthcare-California, Inc (no change in name

of facility). 12/15/99 CHOW, Licensee is now

Beverly Enterprises - Washington, Inc. 7/1/00

CHOW: licensee Eagle Healthcare, Inc.

11/28/12 CHOW & name change. [formerly

Pinewood Terrace Nursing Center]

Providence St. Joseph Hospital CLOSED 0 0 25 0 0 0 40 0 40 aka St. Joseph Hospital of Chewelah 08/13/27

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR STEVENS 132 0 30 0 0 0 40 0 172

ManorCare Health Services-Lacey 1595 120 0 0 0 0 0 0 0 120CN #1392 issued 2/18/09; license issued

5/9/12; 08/05/18 CHOW. 01/01/20 CHOW

Olympia Transitional Care and

Rehabilitation 1511 135 0 0 0 0 0 0 0 135

1/25/96 RA #005 to redistribute 20 beds to

Puget Sound Healthcare Center; after

redistribution completion, total licensed beds

to be 131; 7/1/96 banked 16 beds; 9/3/97

unbank 16 beds; 9/10/97 transfer 16 beds to

PS HC. 11/01/2001-21BB. 07/01/03-convert 6

BB. 07/01/04 convert 4 beds due to expire

on 11/01/05. Extend 11 beds to 11/01/09,

unable to extend again. Conv of 2 beds 1/09 -

BB09-29 Conv 4 beds. 7/1/15 CHOW;

formerly Evergreen Nursing and Rehabilitation

Center

Panorama City Convalescent and


Providence Mother Joseph Care Center 1067 152 0 0 0 0 0 0 0 152 8/95 formerly Mother Joseph Care Center

Puget Sound Healthcare Center 1561 108 0 0 0 0 0 0 0 108

1/25/96 RA #005 to receive 20 beds from

Evergreen Nsg & Rehab; after redist

complete, total licensed beds=120; 9/10/97

transf 16 beds from Evergreen; RA executed

for 16 beds instead of 20 as authorized; 4

beds remain lic at Evergreen; 12/10/99

banked 8 beds. 7/1/01-2 BB. Of the 8 beds

banked, only 2 remain, lost 6. 2 beds

extended to end 12/10/07-no further

extensions.07/01/04 2 BB converted, no bb

remaining. 12/01/17 CHOW.

Regency Olympia Rehabilitation and

Nursing Center 1423 28 0 0 0 0 0 0 0 28


Olympia Manor. 12/9/16 name change-

formerly Olympia Manor

Roo-Lan Healthcare Center 729 96 0 0 0 0 0 0 0 96Voluntary relinqushment of 7 of the 103

licensed beds 7/1/11

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR THURSTON 794 0 0 0 0 0 0 0 794

printed 1/7/2020...12:11 PM 25 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Columbia View Care Center CLOSED 0 0 0 0 0 0 0 35 0

4/7/98 name chg-formerly Columbia View

Care Ctr. 6/1/99 name chg-formerly Sunrise

Care & Rehab for Cathlamet. 8/23/00 banked

3 beds. 9/24/02-convert 3 beds. 10/1/02

CHOW-name chg-formerly SunBridge Health

& Rehabilitation for Cathlamet.10/03/02 17

beds Banked. Extended banking to 2010.

Voluntary relinquishment of 17 beds

6/30/2010 - Voluntary relinquishment of 1

bed 7/2011. Ceased operation of 35 beds

8/1/2012.08/01/20

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR WAHKIAKUM 0 0 0 0 0 0 0 35 0

Park Manor Rehabilitation Center 1476 99 0 0 0 0 0 0 0 99

5/1/94 changed name; 8/1/95 bank 5 beds;

4/6/98 name chg-formerly Blue Mtn Med &

Rehab Ctr. CHOW forfeit 5 beds. 6/1/99

name chg-formerly Sunrise Care & Rehab for

Walla Walla Valley. CN 1326 issued

4/10/2006 to add 30 beds, expires 4/10/2008

unless extended. Bank of 10 beds BB10-04.

08/02/13 loss of 10 AU banked beds.

09/03/14 CHOW for licensing purposes only.

Regency at the Park 1433 106 0 0 0 0 0 0 0 106

11/23/93 banked 4 beds; 7/10/95 bank 11

beds. 3/26/98 RA #018 issued to remodel

Regency at Walla Walla; 7/10/99 extension

request expired forfeit 15 beds. 7/17/01 -

revised total to 86 - per Carole Campbell, only

86 beds licensed at new facility opening on

02/09/99. CN 1322 issued 12/20/2005 to add

20 beds. CN expires 12/20/2007 unless

extended.

Walla Walla General Hospital N/A 0 0 5 0 0 0 0 0 0 07/24/17 Hospital Closed

Washington Odd Fellows Home 351 117 0 0 0 0 0 0 0 117

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR WALLA WALLA 322 0 5 0 0 0 0 0 322

Alderwood Park Health and Rehabilitation 1473 102 0 0 0 0 0 0 0 1029/1/14 CHOW formerly Alderwood Park

Convalescent

Avamere Bellingham Health Care and

Rehabilitation 1460 84 0 0 0 0 0 0 0 84

6/26/95 bank 9 beds; 7/1/98 oper/owner chg;

9/17/98 forfeit 9 banked beds; 1/1/99 banked

14 beds.01/01/03 extended 14 beds per

reconsideration.3/1/02 9 beds banked -

Extended 9 banked beds 3-22-06 - 10-1-06

converted 3 beds back into service and

delicensed 11 - BB08-26 banked 7 additional

beds for remaining 22 months. Voluntary

relinquishment of 16 beds 8/2010. CHOW

04/01/13

Christian Health Care Center 1322 142 0 0 0 0 0 0 0 142

3/5/96 RA#006 (replace with 127 bed facility);

8/1/96 bank 17 beds; lost 4 beds-delic.

w/DSHS prior to bed bank appvl.; RA #006

VOID. 6/29/99 RA #023 issued for the

replacement of Christian Health Care Center

with an 146 bed facility. 11/1/99 banked 7

beds, relinquished 4 beds, total license

capacity is 118. 8/1/00 convert 2 beds &

extend 15 beds (letter sent 6/21/00). 4/9/01

RA#023 completed and NH is licensed.

printed 1/7/2020...12:11 PM 26 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Good Samaritan Society - Stafholt 1587 57 0 0 0 0 0 0 0 57

6/1/99 banked 8 beds.6/1/03-extended 8 BB -

loss of 8 beds w/ 8yr BB expiration. 01/01/19

CHOW

Highland Health and Rehabilitation 1472 44 0 0 0 0 0 0 0 44 9/1/14 CHOW formerly Highland Care Center

Mt Baker Care Center 1333 70 0 0 0 0 0 0 0 70 5/1/96 chg owner;

North Cascades Health and Rehabilitation

Center 1348 122 0 0 0 0 0 0 0 122

7/1/95 bank 5 beds; 8/31/96 banked 8 beds;

4/7/98 name chg-formerly Bayside Health &

Rehab; RA #019 issued 7/9/98; RA #019R

issued 8/4/98. 8/31/99 extend 5 beds banked

on 8/31/95 to 8/31/03. 6/1/99 name chg-

formerly Sunrise Care & Rehab - Bayside.

10/1/99 unbanked 13 beds; 6/26/00 name

chg-formerly Sunbridge Care & Rehab-

Bayside. 08/01/03 CHOW-Cordata

Healthcare. CHOW 02/01/04, new Licensee

Evergreen Kitsap, LLC. aka Evergreen North

Cascades

Shuksan Healthcare Center 1591 52 0 0 0 0 0 0 0 52

8/1/94 facility purchased by Bellingham Assn.

& operated by Sunrise Health; 7/1/95 bank 3

beds; 1/96 formerly Shuksan Convalescent

Center; 7/1/96 banked 6 beds; 4/7/98 name

chg-formerly Shuksan Rehab & Living. 6/1/99

name chg-formerly Sunrise Care & Rehab.

12/1/99 purchased by Eagle Healthcare.

4/13/00 CHOW-lost 9 banked beds. 06/30/01

bank 14 beds. 06/30/05 extend 14 beds, final

expiration on 6/30/09. RA#053 Expired - Conv

14 beds 6/09. 05/12/17 CHOW; no name

change. 12/3/19 CHOW & no name change

St. Francis of Bellingham 1398 120 0 0 0 0 0 0 0 120CHOW 10-1-06 - new licensee St Francis

Operations

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR WHATCOM 793 0 0 0 0 0 0 0 793

Avalon Care Center-Pullman 1361 48 0 0 0 0 0 0 0 48


lost 2 beds-chgd use of rm 3 during banking.

7/1/99 extension request denied, loss of 5

banked beds. 12/15/99 CHOW, Licensee is

now Beverly Enterprises - Washington,

Inc.12/01/03-CHOW-name change from

Palouse Hills Conv Center. 02/23/17 RA #089

issued for replacement of facility to a new site

in Pullman.

Pullman Regional Hospital 5 2/20/90 approval for 5 swing beds

Tekoa Care Center CLOSED 0 0 0 0 0 0 32 0 32

9/30/95 bank 6 beds; 7/20/99 extend bb for 6

beds to 10/1/03. All 6 banked beds forfeited.

09/01/15 CHOW no name change

10/17/18 converting to assisted living facility,

banking 32 beds, relinquishing 33 beds, per

Josh Wester. 10/18/26

Whitman Community Hospital 0 0 5 0 0 0 0 0 0

Whitman Health and Rehabilitation

Center 1240 55 0 0 0 0 0 0 0 55

6/26/95 bank 19 beds; 1/1/98 unbank 19

beds; 4/1/98 name/owner chg-Evergreen WA

HC LLC dba Whitman Hlth & Rehab Ctr;

7/1/98 bank 15 beds. 15 beds forfeited,

request not timely.09/01/03-7 beds banked,

exp 9/1/07. Loss of 7 beds 4yr BB expiration.

Voluntary relinquishment of 14 beds 12/2010

printed 1/7/2020...12:11 PM 27 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR WHITMAN 103 0 10 0 0 0 32 0 135

Crescent Health Care. Inc. 1391 85 0 0 0 0 0 0 0 85

5/1/98 banked 20 beds. 11/7/00 approved 11

beds to be banked effective 11/7/00.Extend

20 BB to 05/01/06. 11 beds banked 11/7/00

expired-no request, 20 BB remaining. 1-29-07

Loss of remaining 20 beds with expiration of

bb period - voluntarily relinquished 8 beds

7/09

Emerald Care 1366 82 0 0 0 0 0 0 0 82

7/1/95 banked 3 beds; 9/1/96 banked 6 beds

71/99 extension request expired forfeit 3

beds. 6/15/00 forfeit 3 beds; converted 3

beds (letter sent 6/15/00). 01/01/04 CHOW,

AKA Emerald Circle Convalescent Center

Garden Village 1437 101 0 0 0 0 0 0 0 101

11/1/96 owner chg: Central Care Inc (Rick

Chasteen Group); 6/1/98 owner chg-Integrity

(Rick Chasteen); 6/1/98 oper chg; Name

change from Central Convalescent 3/99.


Memorial Hospital's Garden Village to be 104

beds at project completion. 12/15/00 facility in

CHOW process. Request to bank 9 beds

after CHOW completed. DOH approval sent

12/15/00. CHOW completed 2/1/01. Banked 9

beds 02/01/01.02/01/05 Extend bed banking

02/01/09 - Conv 09-06 of 9 beds. 01/01/16

relinquished 3 beds

Good Samaritan Health Care Center 1422 105 0 0 0 0 0 0 0 105

6/1/96 change owner; OJR, Inc. to operate &

lease. CHOW to Regency Pacific, Inc. eff.

4/1/2001. 07/01/01 bank 15 beds. 7/11/05-

untimely extension request, forfeiture of 15

beds, none banked.

Heritage Grove TBD 97 0 0 0 0 0 0 0 97

8/1/94 change of operator & name change

(formerly Chalet Healthcare); 8/1/95 bank 7

beds. 8/31/99 unbank 7 beds. 11/1/99 chng

of operator and name (formerly Heritage

Gardens Care Center). 2/1/01 banked 8 beds.

Extend 7of 8 beds banked-due to expire 02-

01-09.- 1 bed lost in room 5. Remaining 7

banked beds + 4 additional (11 total) beds

relinquished. 10/15/09 FFC bed banking of

97 beds. 08/10/15 CN #1557 issued to

Heriitage Grove for a 97 bed NH in Yakima.

Under Thurston County judicial review #17-

2-05158-3 10/15/17

Landmark Care and Rehabilitation 1372 93 0 0 0 0 0 0 0 93

8/9/96 RA #009; 8/9/98 6 month ext. to RA

#009; 7/1/98 bank 8 beds. 7/1/99 unbank 8

beds. 2/1/00 replacement facility and name

chg (formerly Yakima Convalescent Ctr).

CHOW to Aegis Partners, Inc. eff.

3/1/01.01/01/05, New Licensee: Hygate

Properties Inc.

Prestige Care and Rehabilitation-Parkside 1458 88 0 0 0 0 0 0 0 88

9/1/00 CHOW. 11/28/12 CHOW & name

change [formerly Parkside Nursing Care

Center]

printed 1/7/2020...12:11 PM 28 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+


Grandview CLOSED 0 0 0 0 0 0 46 0 46

6/30/95 bank 20 beds; convert date extend to

6/30/01 per Order - addtl 2 yr extend to

6/30/03. Forfeited 20 banked beds. RA #073

approved replacement of 14 beds from

Grandview to Hillcrest Manor. Grandview

total beds is now 46. CHOW 10/01/12

formerly Grandview Health Care Center.

Facility closed 10/24/14; FFC bed banking 10/24/22


Sunnyside 1454 80 0 0 0 0 0 0 0 80

6/30/95 banked 4 beds; convert date extend

to 6/30/01 per Order - addtl 2 yr extend to

6/30/03.14 BB 06/30/01. Forfeited t beds

banked 6/30/95.01/28/05 relinquished 7 BB +

4 additional.06/30/05 extended 14 BB expire

06/03/09=no extensions. Loss of 14 beds in

exp of BB extension 8/09. Formerly Hillcrest

Manor. RA #073 approved renovation &

addition of 14 beds from Grandview, for a

total of 80 beds at Hillcrest Manor. CHOW

10/01/12 formerly Eagle Rehab at Sunnyside

Selah Care and Rehabilitation CLOSED 0 0 0 0 0 0 39 0 39

07/01/17 CHOW w/no name change

08/14/19 approved to bank 39 08/15/27

Summitview Healthcare Center 359 78 0 0 0 0 0 0 0 78

1/15/97 name chg-formerly Summitview

Manor. Banked 18 beds 1/1/99; 3/31/00

banked 35 beds. 5/1/01 banked 3

beds.1/1/03 Voluntary relinquished 6 beds.18

BB 1/1/99 forfeited, not timely. 35 banked

beds forfeited. Loss of three banked beds,

none remaining.

8/2018 - approved reno.auth. for 78 beds

Toppenish Nursing and Rehabilitation

Center 1354 75 0 0 0 0 0 0 0 75

4/1/97 bank 10 beds; 4/6/98 name chg-

formerly Valley Med & Rehab Ctr. 6/1/99

name chg-formerly Sunrise Care & Rehab for

Yakima Valley. Reminder letter to act on 10

banked beds mailed 10/13/00. Extension

granted for 10 beds to 4/1/05.10/01/03-

CHOW- Sunbridge Care & Rehab for Yakima

Valley. 08/25/04 Loss of 10 banked beds due

to CHOW. New Owners Banked 15 07-47 -

Voluntary Relinqishment of 15 beds 6/2010

Willow Springs Care and Rehabilitation 1392 75 0 0 0 0 0 0 0 75

7/1/00 banked 14 beds. 10/27 00 banked 10

beds. 4/9/01 convert 24 beds back to skilled

use. 5/1/01 banked 9 beds.9 beds banked on

05/01/01 lost, none remaining. Old Name:

Renaissance Care Center

-------- -------- -------- -------- -------- -------- -------- -------- --------

BED COUNT FOR YAKIMA 959 0 0 0 0 0 85 0 1,044

STATEWIDE TOTALS 19,162 196 251 45 49 15 1,222 191 20,493

State Owned/Operated - Not Counted:

Fircrest School Pat A, Pat B, Pat N 4088464 King CountyFrances Haddon Morgan Center CLOSED Kitsap CountyLakeland Village Nursing Facility 4088472 Spokane CountyLakeland Village 4012001 Spokane County

printed 1/7/2020...12:11 PM 29 of 30




SWING

BEDS

CN

APPVD

+

RA

REDSTRB

APPVD

+

ALT

USE

SECT 8


NH

LICENSE

NUMBER

LICENSED

BEDS

LICENSED

TYPE A

CCRC

ADJUSTED

TOTAL-

COUNTED

BEDS


BB XPN

DATE

NON-

LICENSEE

CLOSURE

SECT 13 B

LICENSEE

CLOSURE

SECT 13 B

+

Spokane Veteran's Home 4000121 Spokane CountyRainier School Pat A 4012000 Pierce CountyRainier School Pat C 4014000 Pierce CountyRainier School Pat E 4016000 Pierce CountyWashington Soldiers Home 4000014 Pierce CountyWashington Veterans Home - Retsil 4000006 Kitsap CountyYakima Valley School 1045004

Tribal Homes - Not Counted 40 0 0 0 0 8 0 07/20/99 bank 12 beds. 10/9/02 convert 4

beds. 07/20/04

Colville Tribal Convalescent Center 4176400 Okanogan County

printed 1/7/2020...12:11 PM 30 of 30


Documents

NH LICENSED CN LICENSE LICENSED TYPE A SWING APPVD …Hospital Long Term Care Unit. Regency Canyon Lakes Rehabilitation and Nursing Center 1537 53 0 0 0 0 0 0 0 53 8/1/94 change of