Spokane Health & Rehab: Care Plan Failures Miss 26-Pound Loss - WA
The resident's physician documented on April 2, 2025, that weekly paracentesis procedures were required, a process in which a tube is inserted into the abdomen to drain the accumulated fluid. The resident was also taking a diuretic twice a day to further reduce fluid retention. Both interventions would cause the resident's weight to shift, sometimes dramatically, week to week.
Between March 31 and April 15, the resident's weight dropped from 142.7 pounds to 116.2 pounds. Twenty-six and a half pounds in 15 days.
Nobody updated the care plan.
The care plan, initiated April 2, addressed nutrition and hydration in general terms. It called for ice water at the bedside, recording meal intake, a dietician consult as needed, and weights as ordered. A second care plan entry, added April 3, noted the history of alcoholic cirrhosis and ascites and directed staff to watch for signs of alcohol withdrawal. What neither entry mentioned was the weekly paracentesis or the twice-daily diuretic, the two interventions most directly responsible for what would happen to the resident's weight every single week.
The registered dietician who had been assigned to the case said, during an interview with inspectors on April 23, that she was aware of the liver disease, the ascites, and the paracentesis procedures. She expected weight fluctuation for exactly that reason. She agreed the procedures should have been reflected in the care plan. Then she said the nutrition care plan "was not resident specific."
That phrase, offered without apparent alarm, described a document that was supposed to guide individualized care for a medically complex resident. It was not specific to that resident.
Three weeks after admission, the resident was transferred to the hospital.
The residential care manager, interviewed the following morning, said it was important for the care plan to show that the resident received regular paracentesis because it would affect their care. The manager said staff would add it to the care plan when the resident returned from the hospital.
The care plan had been in place for three weeks. The weight had dropped 26.5 pounds. The resident was already gone.
What the inspection report describes is not a mystery or a close call. The clinical picture was well understood. The physician had documented the paracentesis requirement on the same day the care plan was initiated. The dietician knew. The residential care manager knew. The information existed in the medical record. It simply was not placed where the people providing daily care would see it and use it.
A care plan exists so that any staff member, on any shift, understands what is happening with a specific resident and why. For a resident whose weight could swing dramatically from week to week based on scheduled medical procedures, that context is not optional detail. It is the difference between a 26-pound weight loss triggering an urgent clinical response and a 26-pound weight loss going unaddressed for two weeks.
The dietician's concession, that the plan was not resident specific, applied to a resident with cirrhosis, ascites, a hip fracture, a history of alcoholism, weekly invasive procedures, and daily diuretics. There was no version of a generic care plan that was adequate here.
Inspectors cited the facility under Washington state regulations governing care planning. The deficiency was rated at the level of minimal harm or potential for actual harm.
The resident was in the hospital when inspectors finished their review.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Spokane Health & Rehabilitation from 2025-04-24 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
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Last verified: October 30, 2026 · Our methodology
SPOKANE HEALTH & REHABILITATION in SPOKANE, WA was cited for violations during a health inspection on April 24, 2025.
The resident was also taking a diuretic twice a day to further reduce fluid retention.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.