SPOKANE, WA - Royal Park Health and Rehabilitation Center faced federal citations in January 2025 after inspectors found the facility failed to provide adequate restorative services that resulted in functional decline for a resident with Parkinson's disease and neglected to properly notify families about bed-hold rights during hospitalizations.
Restorative Care Program Breakdowns Lead to Physical Decline
The most significant violation centered on the facility's failure to maintain a consistent restorative nursing program for a resident with Parkinson's disease. The resident, identified as Resident 36, experienced a measurable decline in activities of daily living capabilities between October 2024 and January 2025.
According to inspection records, Resident 36 initially required only partial assistance for basic activities like bed mobility and transfers when assessed in October 2024. However, by January 2025, the resident had declined to requiring substantial assistance for multiple daily activities and now needed assistive devices including both a walker and wheelchair.
The resident had been participating in a structured restorative nursing program following discharge from occupational therapy in December 2024. This program was designed to help maintain the functional gains achieved during therapy, including standing balance and transfer abilities. However, participation records revealed significant gaps in service delivery.
Between December 1, 2024 and January 11, 2025, the resident missed entirely two weeks of restorative services during the weeks of December 22-28 and December 29-January 4. During other weeks, participation dropped dramatically from the prescribed frequency.
The breakdown occurred primarily due to staffing issues. Daily staffing records showed that restorative nursing aides were reassigned to direct care duties 16 times over a six-week period, preventing them from providing the specialized rehabilitation services that residents like Resident 36 depended upon to maintain their functional abilities.
Medical Significance of Restorative Care Interruptions
Restorative nursing programs serve a critical function in long-term care, particularly for residents with progressive conditions like Parkinson's disease. These programs bridge the gap between intensive rehabilitation therapy and basic custodial care, helping residents maintain the functional improvements gained during therapy.
For individuals with Parkinson's disease, consistency in movement and exercise is particularly crucial. The condition causes progressive deterioration of motor function, including muscle rigidity, bradykinesia (slow movement), and postural instability. Without regular therapeutic intervention, residents can experience rapid functional decline.
The occupational therapy discharge summary noted that Resident 36 had successfully met goals for increased lower abdominal strength and maintained standing balance when therapy ended in December 2024. However, the subsequent gaps in restorative services coincided with the resident's decline from requiring partial assistance to substantial assistance for basic activities.
Federal regulations require nursing homes to provide services that prevent avoidable functional decline. When facilities fail to maintain consistent therapeutic programs, residents face increased risks of falls, loss of independence, and decreased quality of life.
Communication Failures During Medical Emergencies
Inspectors also documented failures in the facility's notification procedures during resident hospitalizations. When Resident 54 was transferred to the hospital on December 12, 2024, with dangerously low oxygen levels of 74 percent and rapid heart rate, the facility failed to provide required bed-hold notices within the mandated timeframe.
Bed-hold notices inform residents and families of their right to pay the facility to reserve their room during hospitalizations or therapeutic leaves. This notification must occur at discharge or within 24 hours of hospital transfer. However, records showed Resident 54 did not receive this notice until December 16, 2024 - four days after the emergency transfer.
The Admissions Director acknowledged during interviews that bed-hold notices were sometimes delayed until Mondays if a transfer occurred on weekends. This practice violates federal requirements and can leave families without crucial information about their options for maintaining placement at the facility.
Impact on Resident Care and Family Decision-Making
The violations identified represent systemic issues that extend beyond individual cases. When restorative nursing staff are consistently reassigned to other duties, multiple residents likely experience similar gaps in therapeutic services. This pattern suggests inadequate staffing levels or poor resource allocation that prioritizes immediate care needs over preventive interventions.
The resident interviewed by inspectors expressed frustration about the situation, stating: "They were supposed to get restorative therapy, but the restorative aides were usually pulled to direct care assignments." The resident recognized the importance of these services, explaining that "their restorative activity was important to them because they did not want to stiffen up."
Staff members corroborated these concerns, with one restorative aide noting that "consistency was important for Resident 36 because they lost progress quickly without their restorative work." This statement highlights the rapid functional decline that can occur when therapeutic interventions are interrupted.
The bed-hold notification failures create additional stress for families during medical crises. When residents are hospitalized unexpectedly, families must make quick decisions about maintaining their loved one's placement while focusing on immediate medical needs. Delayed notifications can result in lost rooms or unexpected financial obligations.
Industry Standards and Best Practices
Federal regulations establish clear expectations for maintaining resident function and communication during transfers. Nursing homes must provide restorative services sufficient to maintain each resident's highest practicable physical, mental, and psychosocial well-being. This includes ensuring that residents do not experience avoidable decline in activities of daily living.
Effective restorative programs typically involve dedicated staff who are not routinely reassigned to other duties. Industry best practices recommend maintaining therapeutic staffing ratios that account for the specialized nature of restorative care. When facilities consistently pull therapeutic staff for other assignments, it indicates fundamental staffing or prioritization problems.
Regarding transfer notifications, the 24-hour requirement exists to protect resident rights and ensure families can make informed decisions quickly. Facilities should have systems in place to provide these notices immediately, regardless of when transfers occur, including weekends and holidays.
Additional Issues Identified
Beyond the primary violations, the inspection revealed concerns about care coordination and communication systems. The facility's rehabilitation director was unaware of restorative program frequencies, indicating potential gaps in interdisciplinary care coordination.
The timing of the violations is particularly concerning given that Resident 36 was experiencing illness with a urinary tract infection and fever during the assessment period. Medical complications can accelerate functional decline, making consistent therapeutic interventions even more critical during periods of acute illness.
The facility's response to the decline was reactive rather than proactive. Physical therapy was only reinitiated after inspectors identified the functional deterioration, rather than through routine monitoring systems that should detect changes in resident status.
These violations reflect broader challenges in long-term care where facilities must balance immediate care needs with preventive services. However, federal regulations require homes to maintain both levels of care without compromising resident outcomes or rights.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Royal Park Health and Rehabilitation from 2025-01-17 including all violations, facility responses, and corrective action plans.
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