Resident 80 at Life Care Center of Federal Way demonstrated escalating behavioral changes throughout March that went unaddressed by facility management. The resident had diagnoses including depression and cognitive communication deficit, received antidepressant medication, and was under physician orders for staff to monitor exhibited behavior including verbal abuse.
Between March 1st and 15th, nursing staff documented that Resident 80 refused to eat on nine separate days. The resident also showed agitation on four additional days during the same period. Progress notes from March 4th, 9th, and 11th documented ongoing refusals of care.
But records showed no evidence the facility assessed these refusals or notified the provider of behavior changes, despite a care plan that required staff to report changes in behavior and mood.
When an inspector interviewed Resident 80 on March 11th, the resident stated the facility would not let their dog visit anymore and said they were upset with the facility. The resident acknowledged being hungry but said they did not want to eat.
Two days later, inspectors found Resident 80 lying in bed in a darkened room with the lights off. The resident told inspectors "I am not doing very good" but declined to explain what was bothering them.
Staff acknowledged the failures during interviews. The Social Services Assistant said if they had known about Resident 80's refusals, they would have called the family and worked on a plan to correct the behaviors.
The Unit Care Manager stated Resident 80 could become aggressive and would refuse to eat and care. The manager said staff were expected to report refusals of care, after which the Director of Nursing and social worker would meet to discuss them. Staff should have notified the provider and possibly made a hospice referral, "but this did not happen."
The Director of Nursing confirmed staff should have documented refusals and notified the doctor about refused medications, treatments, and care. While Resident 80 had the right to refuse care, "their doctor needed to be notified as it could impact their overall care."
The facility's medication safety problems extended beyond mental health oversight. Inspectors found a medication refrigerator running at 49 degrees Fahrenheit, well above the safe storage range of 36 to 46 degrees. The refrigerator contained staff vaccinations but had no temperature monitoring log.
The Infection Preventionist observed the temperature and confirmed it was too high to store medications effectively. Neither the Director of Nursing nor the Regional Vice President knew who was responsible for checking refrigerator temperatures, though both agreed daily monitoring was essential for medication safety.
In another medication room, inspectors discovered expired drugs including an antibiotic that expired March 6th and a potassium-treating powder that expired in 2023 for a resident who had discharged in May 2023. The Unit Care Coordinator admitted responsibility for removing expired medications "but did not."
A confused resident with dementia had another resident's medicated skin powder placed on their nightstand. The Licensed Practical Nurse said they didn't know why the medication was there and confirmed "it should not be there for Resident 31's safety."
Infection control failures compounded the facility's safety problems. Staff caring for Resident 25, who had bleeding pressure wounds, failed to follow Enhanced Barrier Precautions requiring protective gowns, gloves, and masks.
Inspectors observed two nursing assistants turning and providing incontinence care to Resident 25 without wearing protective gowns, despite the resident's lower back wound having broken red skin that bled. One aide left the room with soiled gloves still on and walked down the hallway.
The same aide later provided incontinence care while passing two other residents to obtain supplies from a closet, never removing soiled gloves or sanitizing hands. The aide told inspectors the room wasn't labeled as requiring Enhanced Barrier Precautions and they "only needed to wear gloves while providing care."
No signage on Resident 25's door directed staff to use Enhanced Barrier Precautions, despite care plans requiring it for the resident's pressure wounds.
Housekeeping staff also violated infection control protocols. Inspectors twice observed a housekeeping assistant removing contaminated gowns outside patient rooms instead of disposing of them inside the rooms in designated garbage bins.
The facility's dietary department lacked proper oversight. The Dietary Manager had not completed required dietary manager training, while the Registered Dietician worked only Tuesdays and Thursdays instead of the full-time schedule required when dietary managers lack certification.
Staff training deficiencies were widespread. Four of five sampled staff members had no documentation of required training in areas including communication, resident rights, abuse prevention, infection control, and cultural competency. The facility had no Staff Development Coordinator to track training requirements.
The Staffing Coordinator said they "relied on staff to come to them when they needed to do their trainings" through an online system. The facility's training curriculum lacked specialized programs for dementia care, behavioral health, or hospice care.
One nursing assistant caring for hospice patients told inspectors they "did not receive training on hospice care." The Unit Care Coordinator didn't know if hospice training was provided and had "no proof that this training was provided by the facility."
Vaccination documentation was similarly inadequate. Four residents received influenza vaccinations in October 2024 without documented education about vaccine benefits and risks. The same residents had no documentation of pneumococcal vaccination offers or historical immunization status.
The Infection Preventionist admitted not having documentation of education or consent for the vaccines and failing to obtain immunization records from the health department as required.
Hospice coordination failures left Resident 25, who had Multiple Sclerosis and pressure injuries, without proper care integration. The facility's hospice binder contained only demographics instead of coordinated care plans or visit notes from the hospice team.
Staff gave conflicting information about pain management responsibilities. One nurse said they "could not give Resident 25 too much pain medication because Resident 25 was on hospice, and hospice managed Resident 25's pain instead of the facility."
Another nurse provided wound treatment when hospice nurses didn't arrive but couldn't recall hospice visit schedules. The Director of Nursing was "unsure where the hospice notes were kept" and said hospice visit notes should have been scanned into medical records "but were not."
Medical records confidentiality was routinely violated when nurses walked away from medication carts with resident health information visible and unsecured. Two different nurses on separate days left patient lists exposed while away from their carts.
Both nurses acknowledged their responsibility to protect resident information. One said they "forgot" to secure the information, while both confirmed the importance of maintaining confidentiality for resident privacy rights.
The inspection revealed systematic failures across mental health care, medication safety, infection control, staff training, vaccination protocols, hospice coordination, and privacy protection. Resident 80 remained in their darkened room, refusing food and expressing distress, while facility systems designed to ensure their safety and wellbeing had broken down around them.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Life Care Center of Federal Way from 2025-03-18 including all violations, facility responses, and corrective action plans.
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