BREMERTON, WA - A July inspection of Bremerton Trails Post Acute revealed significant violations involving expired medications across multiple care units and the employment of unqualified social services staff, putting residents at risk for medication errors and inadequate psychosocial care.
Widespread Medication Safety Failures Discovered
Inspectors documented systematic failures in medication management across all three medication carts at the 120-plus bed facility. The violations involved critical medications including insulin for diabetic residents, eye drops, and over-the-counter supplements that had either expired or lacked proper dating when opened.
During the July 12 inspection, the registered nurse on duty acknowledged that seven insulin pens were either undated when opened or had been open for more than 28 days, exceeding the manufacturer's recommended storage time. The nurse confirmed that "unrefrigerated insulin pens were good for 28 days after opening" but failed to ensure proper dating protocols were followed.
The Cove 2 medication cart contained the most violations, with expired medications affecting at least six residents. These included insulin pens that had been opened in late May and early June - well beyond the 28-day safety window. Additionally, three over-the-counter medications including Vitamin E, multivitamins, and ferrous gluconate had expiration dates ranging from March to May 2024.
Critical Risks to Diabetic Residents
The medication violations pose particularly serious risks for residents with diabetes who depend on insulin for blood sugar control. When insulin expires or degrades due to improper storage timing, it loses potency and becomes less effective at managing glucose levels. This can lead to dangerous fluctuations in blood sugar, potentially causing diabetic ketoacidosis or severe hypoglycemia.
Proper insulin storage protocols require dating insulin pens when first opened and discarding them after 28 days, regardless of remaining medication. The facility's failure to follow these basic safety measures meant residents could have received ineffective insulin without staff awareness of the reduced potency.
Eye medications found violations on the Olympic medication cart, where Combigan and polymyxin eye drops were discovered in a plastic cup with no resident identification or opening dates. Eye drops require particularly strict dating protocols because bacterial contamination can cause serious eye infections. The manufacturer's instructions specify disposal after four weeks of opening, but facility staff failed to track when these medications were first used.
Unqualified Social Services Staff Compromises Care
The inspection revealed that the facility employed social services staff who lacked the required educational qualifications. Both the Social Services Director and Social Services Assistant confirmed they did not possess bachelor's degrees, which are mandatory for facilities with more than 120 beds.
Federal regulations require nursing homes of this size to employ a qualified social worker with either a bachelor's degree in social work or a bachelor's degree in human services with one year of supervised healthcare experience. Social workers play crucial roles in nursing homes, including conducting psychosocial assessments, developing care plans for mental health needs, facilitating family communications, and coordinating discharge planning.
When social services are provided by unqualified staff, residents may not receive appropriate interventions for depression, anxiety, behavioral issues, or family conflicts. This can significantly impact quality of life and may contribute to unnecessary hospitalizations or medication needs that could be addressed through proper psychosocial support.
Food Safety Concerns in Dining Areas
The facility also failed to maintain proper food labeling and dating procedures in the Bayshore Dining Room nourishment refrigerator. Inspectors found multiple opened food items without dates or labels, including chicken products, condiments, and dairy items.
The Dietary Manager acknowledged that "kitchen aids were to temp the nourishment fridges, check dates, and without a date or expired should be thrown out," and stated that items must be "labeled and dated as soon as they put it in." However, the inspection revealed this protocol was not being followed consistently.
Improper food storage and dating can lead to foodborne illnesses, which are particularly dangerous for elderly residents with compromised immune systems. The presence of undated meat products and dairy items creates risks for bacterial growth and contamination.
Industry Standards and Required Protocols
Nursing home medication management follows strict federal guidelines designed to prevent medication errors, which are among the leading causes of adverse events in long-term care. Facilities must maintain detailed records of when medications are opened, ensure proper storage conditions, and dispose of expired drugs promptly.
The Center for Medicare and Medicaid Services requires that all drugs and biologicals be labeled according to professional standards and stored appropriately. For insulin specifically, the American Diabetes Association emphasizes that opened insulin pens must be used within 28 days and stored at room temperature to maintain effectiveness.
Social worker qualifications are equally regulated, with specific educational requirements based on facility size. The rationale behind these standards recognizes that larger facilities serve more complex resident populations requiring specialized psychosocial expertise.
Additional Issues Identified
Beyond the major violations, inspectors noted concerns with the facility's overall compliance systems. The presence of medications without resident names raises questions about medication administration protocols and potential mix-ups between residents.
The systematic nature of these violations across multiple departments suggests possible gaps in staff training, supervision, or facility policies. When both medication management and staffing qualification issues occur simultaneously, it indicates broader organizational challenges that require comprehensive corrective action.
The facility's Director of Nursing acknowledged expectations that "food in all the refrigerators and freezers to be dated and labeled" and stated "it should be dated right away," indicating awareness of proper protocols that were not being implemented effectively.
These violations represent fundamental safety and quality issues that directly impact resident care and wellbeing. The combination of medication management failures, unqualified staff, and food safety concerns creates multiple pathways for resident harm and demonstrates the need for immediate systematic improvements in facility operations.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Bremerton Convalescent & Rehabilitation Center from 2024-07-13 including all violations, facility responses, and corrective action plans.
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