Park Shore

Based on interview and record review, the facility failed to ensure 2 of 5 residents (Resident 4 & 16) were free from significant medication errors. The failure to document and/or provide medications placed the residents at risk for complications, decline in medical condition, and a diminished quality of life.Findings included.Review of the facility's policy titled, Medication Administration-General Guidelines, revised on 01/01/2023, showed Medications are administered in accordance with written orders of the prescriber. The policy showed the individual who administers the medication dose records the administration on the resident's Medication Administration Record (MAR) directly after the medication is given. The policy further showed if a dose of regularly scheduled medication is withheld, refused, not available, or given at a time other than the scheduled time, nursing would document an explanatory note and notify the physician and their response.RESIDENT 4Review of the facility's document titled, Pharmacist's Report to Nursing, recommendation for Resident 4 dated 10/24/2025,…

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, interview and record review, the facility failed to provide routine and as needed medications as prescribed by the physician to meet the needs of 3 of 3 residents (Residents 1, 2 & 3), failed to ensure controlled drugs were accurately accounted for and timely discarded for 2 of 2 residents (Residents 1 and 4), reviewed for medication management and controlled drugs. In addition, the facility failed to document medication administration in accordance with professional standards for 1 of 1 resident (Resident 5), reviewed for medication administration. These failures placed residents at risk for uncontrolled pain, medication errors, negative outcomes, and placed the facility at risk for potential loss and/or drug diversion of the controlled medications.Findings included.Review of the facility's document titled, Medication Administration-General Guidelines, revised on [DATE], showed, Medications are administered in accordance with written orders of the prescriber. The individual who administers…

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 interview and record review, the facility failed to conduct a thorough investigation for 3 of 4 residents (Resident 1, 2 & 3), reviewed for incident investigations. This failure placed the residents at risk for repeated incidents, unidentified abuse and/or neglect, and a diminished quality of life.Findings included .Review of the Nursing Home Guidelines, The Purple Book, Sixth Edition, dated October 2015, showed, A thorough investigation is a systematic collection and review of evidence/information that describes and explains an event or a series of events. It seeks to determine if abuse, neglect, abandonment personal and/or financial exploitation or misappropriation of resident property occurred, and how to prevent further occurrences . All incidents require thorough investigation and reporting, as necessary, according to state and federal regulations.If the suspected perpetrator is staff, interview the other residents the staff person was assigned to.Review of the facility's policy titled, Policy 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.

Based on observation, interview, and record review, the facility failed to ensure foods stored were labeled/dated and discarded after the expiration date or use by date in accordance with professional standards for food safety for 2 of 2 refrigerators (Dairy Refrigerator and Main Walk-In Refrigerator) and 1 of 1 freezer (Walk-In Freezer), reviewed for food services. This failure placed the residents at risk for food borne illness [caused by the ingestion of contaminated food or beverages] and a diminished quality of life. Findings included . Review of the facility's policy titled, Date Marking for Food Safety, revised on 03/01/2024, showed that the food items would be clearly marked to indicate the date or day by which the food shall be consumed or discarded. The policy further showed, the individual opening or preparing a food shall be responsible for date marking the food at the time the food is opened or prepared. DAIRY REFRIGERATOR Joint observation and interview on 10/10/2024 at 8:13 AM with Staff M, Lead Cook, showed an unopened coleslaw dressing with a manufacturer expiration…

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, interview, and record review, the facility failed to ensure an effective pest control program was maintained to keep the facility free of fruit flies (small insects that are attracted to ripe, rotting, or fermenting fruits and vegetables) in the kitchen area of the facility. This failure placed residents at risk for infection, maggot infestation (small, worm like bugs that hatch from fly eggs) and a diminished quality of life. Findings included . Review of the facility's policy titled, Policy and Procedure - Pest Control, revised on 01/02/2024, showed, It is the policy of this facility to maintain an effective pest control program that eradicates and contains common household pests and rodents. Observation on 10/15/2024 at 10:30 AM, and at 10:43 AM showed fruit flies in the dish washing and hand wash areas of the kitchen. Another observation on 10/15/2024 at 11:04 AM showed flies in the kitchen fridge area (where ready to eat cold food were stored). During a joint observation and interview on 10/15/2024 at 11:07 AM with Staff N, Executive Chef, showed that one…

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, interview, and record review, the facility failed to ensure glucometers (portable device used to measure blood sugar) were disinfected properly for 2 of 2 residents (Residents 168 & 14), clean insulin [medication that works by lowering levels of sugar in the blood] pen rubber seal prior to attaching a needle for 2 of 2 residents (Residents 168 & 14), and ensure Enhanced Barrier Precautions (EBP- gown and glove use to protect residents from multidrug-resistant organism [germ that is resistant to medications that treat infections]) practices were followed for 2 of 5 residents (Residents 12 & 68), reviewed for infection control. In addition, the facility failed to ensure hand hygiene practices and/or proper use of gloves were followed for 3 of 7 residents (Residents 168, 15 & 7), reviewed for medication administration, and for 2 of 2 staff (Staff J and I), reviewed for dining observations. These failures placed the residents, visitors, and staff at an increased risk for infection and related complications. Findings included . Review of the facility's policy…

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 interview and record review, the facility failed to accurately assess 1 of 10 residents (Resident 11), reviewed for Minimum Data Set (MDS - an assessment tool). The failure to ensure accurate assessments regarding active diagnosis placed the resident at risk for unidentified and/or unmet care needs, and a diminished quality of life. Findings included . According to the Long-Term Care Resident Assessment Instrument (RAI) 3.0 User's Manual, (a guide directing staff on how to accurately assess the status of residents) Version 1.18.11, dated October 2023, showed, .an accurate assessment requires collecting information from multiple sources, some of which are mandated by regulations. Those sources must include the resident and direct care staff on all shifts, and should also include the resident's medical record, physician, and family, guardian and/or other legally authorized representative, or significant other as appropriate or acceptable . Active Diagnoses- Physician-documented diagnoses in the last 60…

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 interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review (PASARR - a federally required screening of all individuals who has both an Intellectual Disability [ID] or Related Condition [RC] and a Serious Mental Illness [SMI] prior to admission to a Medicaid-certified nursing facility or a significant change of condition) form was completed prior to admission and according to the guidelines specified for 3 of 5 residents (Residents 11, 14 & 68), reviewed for unnecessary medications. This failure placed the residents at risk for inappropriate placement and/or lack of access to specialized services for residents with identified mental health diagnosis or disability. Findings included . Review of the facility's policy titled, PASARR, revised on 04/01/2023, showed that the facility would ensure all residents had a PASARR level I completed on admission and would ensure PASARR Level II referrals were made in accordance with State requirements. The document…

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 interview and record review, the facility failed to develop and implement care plans for 3 of 8 residents (Residents 14, 2 & 6), reviewed for comprehensive care plan. The failure to implement care plans for Activities of Daily Living (ADL), use of medication to reduce swelling, and use of psychoactive [mind-altering] medication to include target behaviors and non-pharmacological interventions placed the residents at risk for unmet care needs and a diminished quality of life. Findings included . Review of the facility's policy titled, Comprehensive Resident Centered Care Plans, revised on 02/09/2024, showed the facility must develop and implement a comprehensive person-centered care plan for each resident . that includes measurable objections and periods to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. Review of the facility's policy titled, Policy and Procedure - Psychoactive Drug use, revised on 07/01/2024, showed, Care plan…

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 interview and record review, the facility failed to revise a comprehensive care plan for 1 of 10 residents (Resident 11), reviewed for care plan revision. The failure to revise the care plan for use of a diuretic (reduce swelling/fluid buildup in the body) and psychoactive [mind-altering] medications placed the resident at risk for unmet care needs and a diminished quality of life. Findings included . Review of the facility's policy titled, Comprehensive Resident Centered Care Plans, revised on 02/09/2024, showed that care plans should be reviewed and revised after each assessment comprehensive and quarterly. The policy further showed that the facility was to update care plans upon change in planned interventions, new diagnosis, and new medications. Review of the facility's policy titled, Psychoactive [chemicals that change the brain and can alter mood, perception, or behavior] Drug Use, revised on 07/01/2024, showed that each resident with a potential need for a psychoactive drug and/or currently…

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 interview and record review, the facility failed to provide necessary assistance with showering/bathing for 1 of 2 residents (Resident 2), reviewed for Activities of Daily Living (ADL). This failure placed the resident at risk for unmet care needs, and a diminished quality of life. Findings included . Review of the face sheet printed on 10/10/2024 showed Resident 2 admitted to the facility on [DATE]. Review of the quarterly Minimum Data Set (MDS - an assessment tool) dated 08/09/2024 showed Resident 2 had severe cognitive impairment and required total assist with showering/bathing. Review of the ADL care plan printed on 10/10/2024, showed Resident 2's showers were scheduled twice a week on Tuesdays and Fridays. The care plan further showed that hospice [a type of end -of-life care that provides comfort, dignity, and peace for people who are dying] services would provide Resident 2 a shower/bath every Monday morning. Review of the facility provided undated and untitled document, showed that room [ROOM…

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 interview and record review, the facility failed to ensure consistent communication and collaboration of care occurred between the facility and hospice care for 1 of 1 resident (Resident 2), reviewed for hospice services. In addition, the facility failed to ensure adverse side effects for diuretic medication (that helps with edema [swelling] to reduce fluid buildup in the body) use and monitoring of edema were conducted for 1 of 1 resident (Resident 11), reviewed for unnecessary medications. These failures placed the residents at risk for not receiving necessary comfort care services, unmet care needs, and a diminished quality of life. Findings included . Review of the facility's policy titled, Nursing Services - Hospice, revised on 02/13/2024, showed that the facility would ensure all documentation of hospice visits were completed according to the state and federal regulations. Review of the face sheet printed on 10/10/2024 showed Resident 2 admitted to the facility on [DATE]. Review of the nursing…

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 interview and record review, the facility failed to ensure target behaviors and non-pharmacological interventions were identified and monitored for residents receiving psychotropic medications (drugs that affects how the brain works, and causes changes in mood, awareness, thoughts, feelings or behavior) for 2 of 5 residents (Residents 6 & 11), reviewed for unnecessary medications. This failure placed the residents at risk for receiving unnecessary medications, adverse side effects, and a diminished quality of life. Findings included . Review of the facility's policy titled, Policy and Procedure - Psychoactive (chemicals that change the brain and can alter mood, perception, or behavior) Drug use, revised on 07/01/2024, showed, Assessment will include the medical symptoms and specific conditions necessitating need for the drug, results of behavior monitoring and interventions .Each resident's behavior monitoring record will be identifying the specific symptoms for which the drug is being used…

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, interview, and record review, the facility failed to appropriately label and store drugs and/or biologicals for 1 of 1 medication refrigerator, reviewed for medication storage. This failure placed the residents at risk for receiving compromised and/or ineffective medications. Findings included . Review of the facility's policy titled, Controlled Substance Storage, dated [DATE], showed that the facility's pharmacy recommended the best practice for storage for schedule II-V medications and other medications subject to abuse or diversion was in a permanently affixed, double-locked compartment separate from all other medications. Review of the facility's policy titled, Medication Storage in the Facility: Storage of Medications, revised on [DATE], showed that the facility should verify the refrigerator or freezer in which vaccines were stored was maintained at the outlined temperature range, at least two times a day, per the Centers of Disease Control and Prevention guidelines. Review of the…

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, interview, and record review, the facility failed to ensure used N95 respirator/mask were discarded, disinfection of face shields were conducted, and use of proper N95 were followed when caring for COVID-19 (a highly transmissible infectious virus that causes respiratory illness and in severe cases can cause difficulty breathing and could result in impairment or death) positive residents in 4 of 4 rooms (Rooms 202, 204, 206 & 208) to non-COVID positive resident in 1 of 1 room (room [ROOM NUMBER]), reviewed for infection control. This failure placed the residents at risk for facility acquired or healthcare-associated infections, and related complications. Findings included . Review of the Washington State Department of Health COVID-19 guidelines, dated June 2023, showed staff need to wear full Personal Protective Equipment (PPE - gown, gloves, N95 respirator/mask and eye protection/face shield) upon entering COVID-19 resident rooms for one resident encounter, then PPE was to be discarded…

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 interview and record review, the facility failed to ensure that unless the facility employed a full time Registered Dietitian, the director of food and nutrition services had completed an academic program in nutrition or dietetics (the application of the science of nutrition to the human being in health and disease) accredited (officially recognized or authorized) by an appropriate national accreditation organization. This failure placed residents at risk of receiving dietary services from staff without the required competencies and skills to carry out food and nutrition services management. Findings included . Review of the facility's undated document titled, Facility Assessment, showed that the facility had a dietitian or other qualified nutrition professional to serve as the director of food and nutrition services. Further review showed that one Certified Dietary Manager (CDM) was required as full-time personnel to meet the needs of the residents. On 06/14/2023 at 11:44 AM, Staff W, Registered Dietitian, stated that they did not work for the facility as full-time or part…

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, interview, and record review, the facility failed to ensure the foods stored in the kitchen were labeled/dated when first opened and ensure thermometers were properly sanitized between use for 2 of 2 kitchen (Main Kitchen and Second Floor Kitchen). In addition, the kitchen staff failed to put on hair restraints while preparing/cooking foods in the Main Kitchen. These failures placed the residents at risk for food borne illness (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life. Findings included . Review of the facility policy titled, Labeling - Dining Services, dated 10/01/2019, showed that food products must be labeled and dated with product name, date the food was produced, and employee initials. Food products that are left in their original containers must be labeled with a date they were opened. Review of the facility policy titled, Food Cooking and Holding Temperatures, dated 05/16/2014, showed that foods must be properly covered, dated, and rotated. All opened containers must have the…

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 interview and record review, the facility failed to ensure the facility assessment was updated to accurately determine and identify the resources needed for the facility's resident care needs. This failure had the potential to affect the provision of care and services for the residents who reside in the facility. Findings included . Review of the facility assessment provided by the facility showed that it was undated, unable to determine when the facility assessment was updated and/or reviewed. Since the last update there had been significant changes such as: - The listed name of the social worker was no longer current. - There was no full-time social services coordinator. - There was no full-time certified dietary manager (CDM). These significant changes affected the day to day and emergency operations systems in the facility and required a comprehensive re-assessment of resources and facility capabilities. Review of the facility assessment provided by the facility showed that assistance with activities of daily living, bowel/bladder status, mental status, special care,…

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, interview, and record review, the facility failed to develop a comprehensive care plan (CP) for 6 of 8 residents (Residents 7, 8, 6, 4, 9 & 13) reviewed for comprehensive person-centered care plan. The failure to develop CPs for residents' skin condition, edema (swelling), pain, self-administration of medications, walker, behavior, and respiratory care placed the residents at risk for unmet care needs and a diminished quality of life. Findings included . Review of the facility's policy titled, Assessment and Plans of Care: Comprehensive Care Planning, revised on 04/01/2023, showed that a comprehensive care plan for each resident used the results of the comprehensive assessment. Each resident's care plan shall include measurable objectives and timetables to meet all resident needs identified in the comprehensive assessment. All items or services ordered to be provided or withheld shall be included in each resident's plan of care. The comprehensive care plan will describe services furnished…

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, interview, and record review, the facility failed to ensure clean linens were covered while transported to the second floor for 3 out of 3 linen closets (linen rooms 1, 2 and 3). In addition, the facility failed to consistently ensure policies and procedures (P/Ps) related to infection prevention and control were reviewed annually as required and the facility failed to perform hand hygiene during wound care. These failures placed the residents at risk for facility acquired or healthcare associated infections and related complications. Findings included . TRANSPORTING CLEAN LINENS On 06/13/2023 at 8:32 AM and on 06/16/2023 at 8:46 AM, Staff K, Custodial and Housekeeping Coordinator, was observed pushing an uncovered wheeled laundry cart with clean towels on it, from the elevator down the hallway to three of the linen storage rooms. Half of the towels were covered in a clear plastic wrap and the other half of the towels were not covered or wrapped. On 06/16/2023 at 8:56 AM, Staff K stated that staff transferred the clean linens in an opened laundry cart with…

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, interview, and record review, the facility failed to complete a self-medication administration assessment for 1 of 1 resident (Resident 6) reviewed for medication at bedside. The failure to complete a self-administration medication assessment placed the resident at risk for medication errors and adverse medication interactions. Findings included . Review of the facility's undated policy titled, Self-Administration of Drugs, showed, resident may self-administer drugs so long as they are capable and willing to do so, and it is accomplished in such a way as to assure accurate documentation by the facility and security of the drug supply. The facility will assess the resident's capabilities, provide instructions for administration, monitor compliance with orders and progress, and will provide safe storage of drugs. Resident 6 admitted to the facility on [DATE]. Resident 6's Medication Administration Records for June 2023 showed the following orders: -Lidocaine (a substance used to relieve pain)…

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 interview and record review, the facility failed to ensure a copy of the Advance Directives was obtained from the residents/representatives who have an Advanced Directives in place and ensure a copy was readily available in the medical records for 2 of 4 residents (Residents 10 and 9) reviewed for Advance Directives. This failure placed the residents at risk of losing their right to have their preferences and choices honored regarding emergent and end-of-life care situations. Findings included . An advance Directives is a written instruction, such as a Living Will or Durable Power of Attorney (DPOA), relating to the provision of health care when an individual is incapacitated. Record review of the facility's policy titled, Resident Rights: Advanced Directives, revised on 01/01/2023, showed that each new admission will be informed of and educated regarding their right to execute Advanced Directives (i.e., Living will, DPOA, and DPOA with Health Care Provision and if necessary, have these same Directives…

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 interview and record review, the facility failed to provide Skilled Nursing Facility - Advance Beneficiary Notices (SNF- ABN) to 2 of 3 residents (Residents 10 & 168) reviewed for beneficiary notifications. The failure to provide residents the information regarding changes in their Medicare services, including potential financial liability and appeal rights, deterred residents from exercising their right to decide on continuation of skilled services and costs associated, as required by the Medicare Program. Findings included . Record review of the facility's policy titled, Beneficiary Notice Policy, revised on [DATE], showed that it is the facility's policy to notify and explain that the individual is no longer receiving Medicare Part A services on the facility belief that Medicare A will not pay for the resident's stay. RESIDENT 10 Review of Resident 10's undated SNF Beneficiary Protection Notification Review, completed by the facility staff showed Medicare Part A services started on [DATE], and an end…

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 interview and record review, the facility failed to report a fall with substantial injury to the State agency within 24 hours for 1 of 1 (Resident 8) reviewed for reporting. This failure placed the residents at risk for abuse and neglect. Findings included . Review of the facility policy titled, Abuse/Neglect, revised on 12/08/2023, showed that all suspected abuse, alleged, or actual cases of resident abuse, including injuries of unknown origin, shall be thoroughly and completely investigated, and reported according to the State and Federal regulations. According to the Nursing Home Guidelines The Purple Book, dated October 2015, in the Reporting Guidelines for Nursing Homes, showed that injuries of unknown source such as substantial, substantial reasonable related, and unknown superficial injuries should be reported to the Department of Social and Health Services (DSHS) Hotline and require DSHS Log within 5 days. Repeated injuries, even when related to condition, may become abuse or neglect if…

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 interview and record review, the facility failed to complete a thorough investigation for a fall with substantial injury for 1 of 1 (Resident 8) reviewed for falls. This failure placed the residents at risk for abuse and neglect. Findings included . Review of the facility policy titled, Abuse/Neglect, revised on 12/08/2023, showed that all suspected abuse, alleged, or actual cases if resident abuse, including injuries of unknown origin, shall be thoroughly and completely investigated, and reported according to the State and Federal regulations. The Nursing Home Guidelines, The Purple Book, dated October 2015, showed that facilities are required to report substantial injuries to the State Agency within 24 hours and that substantial injuries of unknown source must be thoroughly investigated. Injuries of unknown source means any injury sustained by a resident where the source of the injury was not observed directly by a staff person. Substantial injuries of unknown source include injuries that are more…

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 interview and record review, the facility failed to conduct a timely Significant Change in Status Assessment (SCSA) Minimum Data Set (MDS - an assessment tool) assessment for 1 of 2 residents (Resident 5) reviewed for significant change in status assessment. The failure to complete a significant change in status assessment within 14 days placed the resident at risk for unmet care needs and a diminished quality of life. Findings included . Review of the Long-Term Care Resident Assessment Instrument (RAI) dated October 2019, under Section 5.2 Timeliness Criteria, showed Significant Change in Status Assessment must be completed no later than 14 days from the determination date of the significant change in status. A significant change means a major decline in status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of the resident(s) health status. An SCSA is required to be…

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 interview, the facility failed to complete and transmit resident assessment data to the Centers for Medicare & Medicaid Services (CMS) within the required timeframes for 2 of 11 residents (Residents 2 & 5) whose Minimum Data Set (MDS - an assessment tool) were reviewed for timeliness in completion and transmission/submission. The failure to ensure timely completion and transmission of MDS assessments and tracking records placed the residents at risk for unmet care needs and a diminished quality of life. Findings included . According to the Resident Assessment Instrument (RAI)/Minimum Data Set (MDS) Manual, dated [DATE], All Medicare [national health insurance program] and/or Medicaid-certified nursing homes and swing beds, or agents of those facilities, must transmit required MDS data records to CMS's Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system. Required MDS records are those assessments and tracking records that are mandated…

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 interview and record review, the facility failed to accurately assess 2 of 11 residents (Residents 5 and 13) reviewed for Minimum Data Set (MDS) assessment. The failure to ensure accurate assessments regarding prognosis of life expectancy of less than 6 months, pressure ulcer/injury (to skin and underlying tissue resulting from prolonged pressure on the skin), and Preadmission Screening and Resident Review (PASRR) placed the residents at risk for unidentified or unmet care needs and a diminished quality of life. Findings included . According to the Long-Term Care Resident Assessment Instrument (RAI) 3.0 User's Manual, Version 1.17.1, revised in October 2019 showed: Accuracy of Assessment means that the appropriate, qualified health professionals correctly document the resident's medical, functional, and psychosocial problems and identify resident strengths to maintain or improve medical status, functional abilities, and psychosocial status using the appropriate RAI (i.e., comprehensive, quarterly,…

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 interview and record review, the facility failed to ensure a Preadmission Screening and Resident Review (PASRR) was completed for 1 of 5 residents (Resident 13) reviewed for PASRR. This failure placed the resident at risk for unmet care needs. Findings included . Review of the facility policy titled, PASRR Policy, revised on 04/01/2023, showed that if a PASRR level 1 was not completed, the facility Social Service team member or designee will complete it. Resident 13 was admitted to the facility on [DATE]. Review of Resident 13's electronic medical records did not show that a PASRR document was completed. On 06/15/2023 at 3:57 PM, Staff B, Director of Nursing, stated that newly admitted residents were reviewed for PASRR and that the social worker or staff in the facility usually follows-up with the place where the resident came from if they came without a PASRR. Staff B further stated that Resident 13 had no PASRR screening completed at time of admission. Reference: (WAC) 388-97-1915(1) .

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure baseline care plans were developed within 48 hours of admission to ensure continuity of care and/or to ensure a summary/copy of the baseline care plan was provided to the residents and/or their representatives for 2 of 3 residents (Residents 166 & 116) reviewed for baseline care plan. This failure resulted in the residents not being informed of their initial plan for delivery of care services and placed the residents at risk for unmet care needs. Findings included . Record review of the facility's policy titled, Baseline Care Plan, revised on 01/31/2023, showed that a baseline care plan will be developed for all newly admitted resident within 48 hours of admission. The facility will provide the resident and their representative with the summary of the baseline care plan that includes and is not limited to the following: The initial goals of the resident, a summary of medications and dietary restrictions, any services and treatment to be…

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 interview and record review, the facility failed to review and revise Care Plans (CPs) for 1 of 8 residents (Residents 8) reviewed for care planning. The failure to review and revise care plans by the interdisciplinary team after each assessment placed the residents at risk for unidentified/unmet care needs and a diminished quality of life. Findings included . Review of the facility policy titled, Assessment and Plans of Care, revised on 04/01/2023, showed that each resident's plan of care shall be reviewed and revised by an interdisciplinary team after each comprehensive assessment is conducted. Review of the facility policy titled, Fall Management, reviewed on 04/01/2023, showed that revision to the care plan will be documented in the chart and communicated to caregivers. The facility will have in place a fall management protocol utilizing assessments and interventions to minimize the risk of falling for residents to reduce and prevent the number of falls and number of injuries related to falls for…

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, interview, and record review, the facility failed to ensure resident-centered care and treatment were provided in accordance with professional standards of practice when facility staff failed to do skin evaluations, implement monitoring and interventions for skin care for 2 of 3 residents (Residents 7 & 166) reviewed for skin conditions. Additionally, the facility failed to ensure consistent communication and collaboration of care occurred between the facility and hospice care for 1 of 2 residents (Resident 5) reviewed for hospice services. These failures placed the residents at risk for wound infection, not receiving the necessary wound/skin treatments, not receiving necessary comfort care services, unmet care needs, and a diminished quality of life. Findings included . Review of the facility's policy titled, Skin Care Policy, dated 10/25/2017, showed that residents will be assessed on admission; residents will have weekly skin checks and will have additional interventions as per…

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, interview and record review, the facility failed to ensure resident receive necessary treatment, consistent with professional standards of practice to an existing pressure ulcer ( also known as pressure sores, are localized damage to the skin and/or underlying tissue that usually occur over bony parts of the body) for 1 of 1 resident (Resident 13) reviewed for pressure ulcer. This failure placed the resident at risk of worsening pressure ulcer. Findings included . Review of facility's policy, titled, Assessment and Treatment Service to Wound, revised on 04/12/2023, stated that resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing. Review of facility's policy, titled, Skin Care Policy, stated that facility suggested skin protocols for care and treatment of open areas will be followed unless otherwise ordered by the physician. All treatments will…

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, interview and record review, the facility failed to provide necessary foot care in accordance with professional standards for 1 of 1 resident (Resident 7) reviewed for ADLs (ADLs-Activities of Daily Livings) and foot care. This failure placed the resident at risk for pain/discomfort and diminished quality of life. Findings included . Resident 7 admitted to the facility on [DATE] with diagnoses of Peripheral Neuropathy (damaged end nerves causing loss of sensation and weakness to the lower extremities) and hammer toe deformity (a change from the normal shape of the second, third, fourth, or fifth toe). Review of the medical practitioner notes dated 04/24/2023 showed, Referral to podiatry (treating feet problems, foot doctor) for regular foot care. On 06/14/2023 at 10:00 AM, Review of the June 2023 task list showed direction for Certified Nursing Assistant, Licensed Nurse (RN -Registered Nurse/LPN- Licensed Practical Nurse) to complete nails and pedicure as needed. According to the task list,…

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, interview, and record review, the facility failed to ensure proper care of a suction machine (a medical device used to remove mucus/saliva secretions/blood obstruction from a person's airway) including the suction tubing and suction canister for 1 of 2 crash cart (a medical device containing necessary equipment and supplies for use during emergencies) (Suction Machine in Second Floor Dining Room/Solarium). Additionally, the facility failed to ensure oxygen (O2) therapy was given according to standards of practice for 1 of 1 resident (Resident 13) reviewed for respiratory care. These failures placed the residents at risk for unmet care needs, respiratory infections, and related complications. Findings included . Review of the facility policy titled, Care of Suctioning Equipment, revised on 04/01/2023, showed that nursing and designated personnel will change supplies and disinfect and/or prepare equipment for sterilization according to the procedures to prevent the incubation and/or…

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 interview and record review, the facility failed to ensure monthly pharmacy recommendations were followed up on for 1 of 5 residents (Resident 6) reviewed for unnecessary medications. This failure placed the resident at risk of receiving unnecessary medications, medication-related adverse consequences, and a diminished quality of life. Findings included . Review of the facility's policy titled Consultant Pharmacist Reports, revised on 01/01/2023, showed that the facility should present the provider with recommendations and obtain follow up within 30 days or based on urgency of recommendation. A designated facility staff member should monitor for weekly reports to ensure recommendations are completed in a timely manner ., the administer and/or director of nursing will contact the providers who fail to respond to recommendations in a timely manner . Recommendation are acted upon and documented by facility staff and or prescriber. Resident 6 admitted to the facility on [DATE]. Resident 6's Medication…

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, interview, and record review, the facility failed to properly label and store medications (no open date or not dating medications after opening it) and failed to ensure expired medications were disposed of timely in accordance with current accepted professional standards for 1 of 1 medication storage room and 1 of 2 medication carts (Cart 2) reviewed for medication storage. Additionally, the facility failed to maintain proper temperature for 1 of 2 refrigerators in the medication storage room (Refrigerator 1 for medication). This failure placed the residents at potential risk to receive expired medications and to receive compromised or ineffective medications with unknown potency. Findings included . Review of the facility policy titled, Temperature Fridge Log, revised on 04/12/2023, stated that the facility will monitor and make steps to keep refrigerator temperature according to the pharmacy recommendation: medical fridges have the latest thermometers that continuously monitor and record temperatures for reassurance. They also are fitted as standard with…

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.