Grangeville Health & Rehabilitation of Cascadia

Based on observation, Food Drug Administration (FDA) Food Code review, record review, and staff interview, it was determined the facility failed to ensure kitchen equipment was maintained, cleaned, and sanitized. These deficiencies had the potential to affect the 42 residents who consumed food prepared by the facility. This placed residents at risk for potential foodborne illnesses and adverse health outcomes. Findings include:The FDA Food Code Section 4-602.11 Equipment Food-Contact Surfaces and Utensils documented, surfaces of utensils and equipment contacting food that is not time/temperature control for food shall be cleaned. Absent manufacturer specifications, at a frequency necessary to preclude accumulation of soil or mold.The FDA Code Section 4-602.12 Cooking and Baking Equipment documented, food-contact surfaces of cooking equipment must be cleaned to prevent encrustations that may impede heat transfer necessary to adequately cook food. Encrusted equipment may also serve as an insect attractant when not in use.The FDA Food Code Section 6-501.12 Cleaning, Frequency and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of the Resident Assessment Instrument (RAI) Manual, record review, and staff interview, it was determined the facility failed to ensure residents' Minimum Data Set (MDS) Assessments included correct assessment information. This was true for 1 of 2 residents (#5 and #26) whose MDS records were reviewed for accuracy. This deficient practice had the potential for negative outcomes if residents were not assessed and/or monitored due to inaccurate assessments. Findings include:The RAI Manual, revised 10/1/2024, documented section A1500, PASRR (Preadmission Screening and Resident Review), was to be coded yes when a PASRR Level II screening determined a resident had a serious mental illness and/or intellectual disability, or related condition. 1. Resident #5 was admitted to the facility on [DATE], with multiple diagnoses including paranoid schizophrenia and adjustment disorder with mixed anxiety and depressed mood. Resident #5's Annual MDS Assessment, dated 8/8/24, documented under A1500 in Section A,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, and record review, it was determined the facility failed to ensure a licensed nurse had the specific skill set necessary to appropriately administer an insulin injection. This was true for RN #1, when she was observed administering an insulin injection. This failure created the potential for adverse effects if the resident did not receive the complete dose of their insulin. Findings include:The [NAME] Pharmaceuticals, Semglee Prefilled Insulin Pen- Instructions For Use, approved 7/2021, documented the following instructions:- Always perform the safety test before each injection. Performing the safety test ensures that you get an accurate dose by ensuring that pen and needle work properly and removing air bubbles. The safety test instructions direct the person preparing the injection, after attaching a new pen needle, to select a dose of 2 units of insulin, to hold the pen needle pointing upwards, tap the cartridge so that any air bubbles rise up to the needle, then press…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, and record review, it was determined the facility failed to ensure infection prevention standards of practice were maintained during insulin administration. This was true for RN #1 when she was observed administering an insulin injection. This failure created the potential for harm to all residents in the facility by placing them at risk for cross contamination and infection. Findings include:The [NAME] Pharmaceuticals, Semglee Prefilled Insulin Pen- Instructions for Use, approved 7/2021, documented to always wipe the rubber seal on the insulin pen with alcohol before attaching a new pen needle on to the insulin pen.The Centers for Disease Control (CDC) Infection Control, Standard Precautions for All Patient Care, web page, dated 4/3/24, accessed on 8/14/24, documented Standard Precautions are used for all patient care. They're based on a risk assessment and make use of common sense practices and personal protective equipment use that protect healthcare providers from…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, CDC guidance, policy review and staff interviews, it was determined the facility failed to ensure residents were offered and/or administered the appropriate pneumococcal vaccine as indicated. This was true for 2 of 5 residents (#5 and #13) reviewed for pneumococcal immunizations. This deficient practice placed residents at risk of developing pneumococcal pneumonia, a potentially life-threatening condition. Findings include:The facility's Pneumococcal Program policy for residents revised 2/22/22, documented the following:Adults 65 years or older who have not previously received PCV (a form of pneumococcal pneumonia vaccine) or whose previous vaccination history is unknown, should receive 1 dose of either PCV20 or PCV15. a. If PCV20 is used, no additional dosing recommended. b. If PCV15 is used, it should be followed by a dose of PPSV23 (another form of pneumococcal pneumonia vaccine) one year later.Adults aged 19-64 years with certain underlying medical conditions or other risk factors who…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, CDC guidance, and staff interview, it was determined the facility failed to ensure COVID-19 vaccinations were offered and administered to the residents. This was true for 1 of 5 residents (Resident #17) whose COVID-19 vaccinations were reviewed. This deficient practice placed residents at risk of severe illness, hospitalization, and death due to SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus - the virus that causes the COVID-19 illness) and had the potential to affect all residents in the facility. Findings include:The CDC website article titled: Staying Up to Date with COVID-19 Vaccines dated 6/6/25 and accessed on 8/15/25 documented:Protection from COVID-19 vaccine decreases over time.Immunity after COVID-19 infection decreases with time.The 2024-2025 vaccine is especially important if you: a. Never received a COVID-19 vaccine, b. Are ages 65 years and older c. Are at high risk for severe COVID-19 d. Are living in a long-term care facility.1. Resident #17 was initially…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of the Payroll Based Journal (PBJ) Staffing Data Report, record review, and staff interview, it was determined the facility failed to ensure an RN was on-site for 8 consecutive hours, 7 days a week. This failure created the potential for harm if routine and/or emergency nursing needs were unmet and had the potential to affect the 46 residents living at the facility. Findings include: The facility's PBJ Staffing Data Report for Fiscal Year, Quarter 3, 2024 (April 1 - June 30), documented the facility reported an RN was not on-site on the following 7 dates: -Sunday 4/7/24 -Saturday 4/20/24 -Sunday 4/21/24 -Saturday 5/4/24 -Sunday 5/5/24 -Saturday 6/1/24 -Saturday 6/15/24 The facility's Three-Week Nursing Hours worksheet, completed by the Administrator, documented there fewer than 8 consecutive hours of RN on-site coverage for the following 6 dates: -Sunday 9/29/24 documented 1.50 RN hours -Saturday 10/5/24 documented 2.25 RN hours -Sunday 10/6/24 documented 1.38 RN hours -Saturday 10/12/24 documented 0.00 RN hours -Sunday 10/13/24 documented 4.22 RN hours -Saturday…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, it was determined the facility failed to ensure a Pre-admission Screening and Resident Review (PASARR), was completed within the required timeframe for 1 of 5 residents (Resident #40) reviewed for PASARR screenings. This failure created the potential for harm if residents required, but did not receive, specialized services for mental health while residing in the facility. Findings include: Appendix PP of the State Operation Manual, revised 8/8/24, documented all applicants to Medicaid-certified nursing facilities are to be screened for possible serious mental disorders or intellectual disabilities and related conditions. This initial pre-screening is referred to as PASARR Level 1 and should be completed prior to admission to a nursing facility. Resident #40 was admitted to the facility on [DATE], with multiple diagnoses including traumatic brain injury and alcohol-induced dementia. Resident #40's care plan, created on 9/4/24, documented Resident #40 was prescribed an…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, policy review, and staff interview, it was determined the facility failed to ensure food was prepared and served under sanitary conditions when staff members' hair was observed not properly restrained in a hairnet. This failure created the potential for each of the 38 residents residing at the facility to be exposed to food contamination and potential disease-causing pathogens. Findings include: The facility's policy and procedure for Food Handling, dated 6/13/18, directed food handlers to wear hairnets or caps to effectively keep hair from contacting exposed food, clean equipment, utensils and linens. The 2017 Food and Drug Administration Food Code, Chapter 2, regarding hygienic practices and hair restraints, documented Food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food, clean equipment, utensils, and linens and unwrapped single-service and single-use articles. On 2/3/20 at 11:35 AM, Dietary…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interview, and policy review, it was determined the facility failed to ensure staff performed proper hand hygiene and appropriate peri-care during resident cares. This was true for 1 of 4 residents (Resident #3) who was observed during resident cares. The deficient practice placed residents at risk of infection from cross-contamination. Findings include: The facility's policy and procedure for Handwashing, dated 6/13/18, directed staff to wash their hands before applying and removing gloves, before handling clean supplies or equipment, and before and after contact with non-intact skin, mucous membranes, blood, or any moist body fluid, even if gloves were worn during contact. The facility's policy and procedure for Incontinent Care While in Bed, dated 2/27/18, documented staff were to: * Remove the incontinent brief from the patient by rolling the brief/pad toward the inside soiled area, and remove the brief from front to back containing the fecal matter as much as possible * Cleanse the skin of patient from front to back and clean to dirty using…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, it was determined the facility failed to ensure informed consent was obtained prior to initiation of medications for 2 of 5 residents (#5 and #32) who were reviewed for unnecessary medications. This deficient practice placed residents at risk of receiving medications without knowledge of the risks and benefits associated with the medications and the right to refuse the medications. Findings include: a. Resident #5 was admitted to the facility on [DATE], with multiple diagnoses including dementia. Resident #5's physician's order included Donezepil (used to treat confusion related to dementia) 5 mg at bedtime, started on 10/25/18. Resident #5's record did not include documentation he consented to the Donezepil, or was informed about beneficial effects and possible side effects of the medication. b. Resident #32 was admitted to the facility on [DATE], with multiple diagnoses including post-concussion syndrome (a condition associated with a head injury causing symptoms…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, policy review and staff interview, it was determined the facility failed to ensure professional standards of practice were followed when a) blood pressure medications were held when a resident's pulse was outside of ordered parameters for 1 of 5 residents (Resident #12) reviewed for unnecessary medications; and b) staff failed to dispose controlled medications consistent with the facility's policy to prevent drug diversion for 2 of 2 licensed nurses (LPN #1 and LPN #2) who were interviewed during medication cart inspection. These failed practices placed Resident #12 at risk of dangerously low blood pressure, and created the potential for harm for each of the 38 residents residing in the facility if controlled medications were diverted and residents did not receive medications as ordered. Findings include: 1. Resident #12 was admitted to the facility on [DATE], with multiple diagnoses including hypertension (high blood pressure). Resident #12's physician orders included the following: *…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview and record review, it was determined the facility failed to ensure residents receiving psychotropic medications had clear indications for use of the medications and clinical rationale supporting the continued use of the medications. This was true for 1 of 5 residents (Resident #12) whose records were reviewed for unnecessary medications. This deficient practice had the potential for harm if residents received psychotropic medications that were unwarranted and used for excessive duration. Findings include: Resident #12 was admitted to the facility on [DATE], with multiple diagnoses including depression and anxiety. Resident #12's quarterly MDS assessment, dated 11/25/19, documented she was cognitively intact and received anti-psychotic and anti-depressant medications in the past 7 days. Resident #12's physician order report for 2/1/20 to 2/29/20, included the following: * Zoloft (anti-depressant medication) 50 mg tablet once a day for depression. * Risperdal (anti-psychotic medication) 1…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.