ARLINGTON, WA - A federal inspection at Arlington Health and Rehabilitation identified significant deficiencies in medication management, infection control practices, food safety protocols, and hospice care coordination during a February 2025 survey conducted while the facility was experiencing a gastrointestinal virus outbreak.
Medication Storage and Management Failures
Inspectors documented multiple violations in the facility's medication handling practices that placed residents at risk for receiving ineffective or expired medications. During the inspection, surveyors discovered three vials of lorazepam—an anti-anxiety medication—stored in the medication room refrigerator with an expiration date of October 2024, four months past their usability date. Additionally, inspectors found a bag labeled "Promethegan" where the original 2023 expiration date had been crossed out and replaced with a handwritten date of April 2025.
These findings raise concerns about the facility's medication management systems. Expired medications can lose their potency and effectiveness over time, potentially failing to provide residents with the intended therapeutic benefits. When medications are not stored according to manufacturer specifications, their chemical stability may be compromised, leading to reduced efficacy or altered pharmacological properties.
The inspection also revealed improper storage of medications requiring refrigeration. An open bottle of Acidophilus, a probiotic supplement with clear "refrigerate after opening" instructions, was discovered in an unrefrigerated medication cart on the Medicare Hall. Probiotics contain live bacterial cultures that require specific temperature conditions to remain viable. When stored at room temperature, these beneficial bacteria can die off, rendering the supplement ineffective for maintaining digestive health and immune function.
According to facility staff interviews, the night shift held responsibility for removing expired medications from the medication room, while all nurses were expected to check their medication carts for expired items "when time allows." This system-dependent approach to medication oversight, rather than a structured protocol with regular monitoring schedules, contributed to the accumulation of expired and improperly stored medications.
Professional pharmacy standards require medications to be stored according to manufacturer specifications and regularly audited for expiration dates. The presence of expired medications suggests gaps in the facility's quality assurance processes, while improper storage temperatures can accelerate medication degradation and compromise therapeutic effectiveness.
Infection Control Deficiencies During Outbreak
The inspection documented widespread failures in infection prevention and control practices across multiple areas of the facility, particularly concerning given the ongoing gastrointestinal virus outbreak at the time of the survey. Inspectors observed staff failing to follow Enhanced Barrier Precautions (EBP) protocols, which are specialized infection control measures designed to prevent transmission of drug-resistant organisms and protect residents with wounds or indwelling medical devices.
Facility policy required staff to use personal protective equipment during high-contact resident care activities such as toileting, transferring, and wound care for residents under Enhanced Barrier Precautions. However, inspectors observed a nursing assistant providing perineal care to a resident with a cholecystostomy tube without wearing a gown, despite this being classified as a high-contact activity. The same staff member removed contaminated gloves and applied new gloves without performing hand hygiene between glove changes, stating "it will take ten minutes to dry their hands."
This practice directly contradicts infection control principles. Hand hygiene represents the single most important measure for preventing healthcare-associated infections. When staff skip hand hygiene between glove changes, they risk transferring microorganisms from their contaminated hands to clean gloves, which can then spread pathogens to residents, surfaces, and equipment.
Inspectors also documented concerning wound care practices. A licensed practical nurse performed dressing changes on multiple wounds on a resident's feet using the same pair of gloves throughout the entire procedure. The nurse moved from cleaning one wound, reaching over sterile supplies, drying the wound, and applying new dressings, then repeating this process for three separate wounds without changing gloves. When questioned, the staff member stated they only needed to change gloves when moving "from one area of the body to another, such as when they go from the buttocks to another area."
This approach fails to prevent cross-contamination between wound sites. Each wound can harbor different bacterial populations and varying contamination levels. Using the same gloves across multiple wounds can transfer bacteria from one site to another, potentially introducing more virulent or drug-resistant organisms to previously less-contaminated areas. Standard wound care protocols require changing gloves between different wound sites to maintain aseptic technique and minimize infection risk.
The facility also demonstrated inconsistent implementation of Enhanced Barrier Precautions. One resident with a history of respiratory MRSA (methicillin-resistant Staphylococcus aureus) and an active multi-drug resistant bacterial lung infection had no precaution signage outside their room. When questioned, nursing staff stated the resident didn't require precautions because they weren't actively coughing, despite physician orders documenting the need for Enhanced Barrier Precautions. The infection preventionist later acknowledged this represented a "miscommunication" between departments.
Confusion about precaution protocols extended to basic signage systems. When asked about the meaning of blue rectangular magnets on door frames—the facility's system for indicating residents requiring Enhanced Barrier Precautions—three different nursing assistants provided three different explanations: two-person assist required, fall risk, or behavioral precautions needed.
Inspectors also observed improper catheter management practices. One resident's urinary catheter collection bag was repeatedly found either resting on the floor, lying in the trash bin on top of garbage, or hanging on the edge of the trash bin with the bottom touching the floor during multiple observations over three days. Catheter bags should never contact the floor or garbage, as this creates a direct pathway for bacteria to travel up the catheter tubing and into the bladder, significantly increasing urinary tract infection risk.
Food Safety and Service Quality Issues
The facility failed to maintain proper food safety standards in multiple locations. Inspectors found numerous unlabeled and undated food items in the main kitchen refrigerator, including opened applesauce, cottage cheese, and freezer jam—despite a posted notice stating "all items in the refrigerators/freezers need to have labels with item and date on them no exceptions."
Dating opened food items is fundamental to food safety management. Without date labels, staff cannot determine how long perishable items have been stored or when they should be discarded. Most opened dairy and prepared food products remain safe for only 3-7 days under refrigeration. The presence of undated items creates risk for serving spoiled or contaminated food that could cause foodborne illness.
In an outdoor refrigerator, inspectors discovered four cucumbers wrapped in plastic with "visible black circles" that were "mushy to touch"—clear indicators of spoilage and decomposition. The dietary manager stated these vegetables had been delivered approximately five days prior and acknowledged they should have been discarded.
The nourishment refrigerator in the dining room contained multiple improperly stored items, including an unlabeled fast-food bag with a roast beef sandwich, opened egg nog with no date, opened milk with no date, and a med-pass supplement dated "8-4" (presumably August 4th, discovered in late January). Dietary staff stated they checked nourishment refrigerators weekly and that opened items could only be kept for three days before requiring disposal—yet multiple items exceeded these timeframes.
Beyond storage issues, residents reported ongoing concerns about meal service quality during Resident Council meetings. Multiple residents stated food was "consistently cold and late" and "especially bad on the weekends" when the dietary manager was absent. Inspectors observed breakfast meal carts sitting in hallways for extended periods before being served to residents. When a dietary manager checked food temperatures on a remaining breakfast tray at 8:59 AM, the oatmeal measured 124 degrees Fahrenheit—well below the facility's own policy standard of 165 degrees Fahrenheit for hot cereals.
Temperature control is critical for both food safety and palatability. Hot foods held below proper temperatures enter the "danger zone" (40-140°F) where bacteria multiply rapidly, increasing foodborne illness risk. Additionally, cold food reduces resident satisfaction and appetite, potentially contributing to inadequate nutritional intake, particularly among elderly residents who may already face challenges with appetite and eating.
Hospice Care Coordination Gaps
The facility failed to maintain adequate coordination with hospice providers for end-of-life care. Inspectors found that one resident who had been enrolled in hospice services since November 2024 had no hospice plan of care in their electronic health record, despite the presence of multiple hospice nursing notes.
The facility's contract with the hospice provider specifically required coordination in developing and monitoring the resident's hospice care plan, with the nursing facility agreeing to "abide by the plan of care." However, facility staff could not locate the hospice care plan during the inspection. When asked about hospice coordination, staff stated care plans were "developed by the resident care manager" and "coordinated through nursing," but could not explain why the hospice plan was missing from the resident's record.
This resident experienced documented behavioral changes including confusion, agitation, anxiety, and wandering behaviors that required multiple interventions, including calls to family members to help calm them. Without an integrated hospice care plan accessible to facility staff, nurses and aides may lack crucial information about symptom management strategies, medication protocols for comfort care, and individualized approaches for addressing behavioral symptoms common in end-of-life care.
The staff eventually located and provided a hospice care plan on the final day of the inspection, with a date stamp showing it had been printed that same day. This suggests the document may not have been readily available to guide day-to-day care decisions for this resident experiencing significant end-of-life symptoms.
Effective hospice care requires seamless communication and coordination between the hospice team and facility staff. When hospice care plans are not integrated into facility care planning systems, residents may not receive the full benefit of specialized palliative interventions, comfort measures, and symptom management strategies that hospice providers develop.
Additional Issues Identified
The inspection documented several other compliance concerns. Staff demonstrated inconsistent knowledge about infection control requirements and facility protocols. Housekeeping staff were observed removing contaminated gloves and immediately donning clean gloves without hand hygiene, stating this represented their "usual practice." During an enteric outbreak requiring soap-and-water handwashing, a registered nurse used only hand sanitizer when leaving an isolation room and failed to disinfect equipment before removing it from the precaution area, contaminating clean supply storage.
The facility's system for tracking which residents required Enhanced Barrier Precautions proved inadequate, with staff providing contradictory information about the meaning of precaution indicators and failing to implement required protocols even when physician orders documented the need for such measures.
These findings reflect systemic challenges in staff training, quality assurance monitoring, and standardization of practices across different shifts and departments. The Centers for Medicare & Medicaid Services classified these violations as constituting "minimal harm or potential for actual harm," requiring the facility to submit plans of correction addressing each identified deficiency.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Arlington Health and Rehabilitation from 2025-02-05 including all violations, facility responses, and corrective action plans.
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