SPOKANE, WA - Federal inspectors cited Spokane Health & Rehabilitation for multiple violations involving food service and emergency preparedness during an April 2025 inspection that revealed systematic failures affecting resident care and safety.
Repeated Food Preference Violations
The most significant issues centered on the facility's failure to honor resident meal requests and dietary preferences. Inspectors documented three residents who consistently received incorrect meals despite clearly communicating their choices.
Resident 15, who was cognitively intact, experienced repeated frustrations when meals did not match their selections. On April 16, the resident was served barbequed ribs and mashed potatoes after ordering shrimp scampi. "They were upset. They had ordered the shrimp scampi and filled out their menu twice," inspectors noted.
The pattern continued the following day when Resident 15 received a chicken patty instead of their alternate menu choice. "They stated they had filled out their menu twice and had given it to an aide," according to the inspection report. On April 18, breakfast brought another disappointment when scrambled eggs were served instead of the requested boiled eggs.
"They stated they were tired of getting sent the wrong things despite filling out the menus," the resident told inspectors, highlighting the ongoing nature of the problem.
Impact on Residents with Special Needs
The violations particularly affected residents with specific dietary requirements. Resident 63, diagnosed with failure to thrive and moderate cognitive impairment, received foods explicitly listed on their dietary profile as dislikes.
Despite clear documentation that Resident 63 disliked scrambled eggs and potatoes, breakfast on April 18 included both items. The resident consumed only sausage and oatmeal, leaving the eggs and hashbrowns untouched. "Resident 63 stated they were not offered alternative options," inspectors documented.
This situation demonstrates how meal preference violations can compound health risks for vulnerable residents. When residents with failure to thrive cannot or will not eat provided meals, nutritional status may deteriorate further.
Kitchen Safety and Sanitation Failures
Beyond meal preference issues, inspectors identified numerous food safety violations that could expose residents to foodborne illness. The kitchen environment showed signs of poor maintenance and inadequate cleaning procedures.
Food debris and crumbs were found throughout critical areas including service carts, stove surfaces, and the walk-in freezer floor. Inspectors discovered ice cream cups and plastic wrapper debris on the freezer floor, indicating inadequate cleaning protocols.
Improper Food Storage and Labeling
Multiple food items lacked proper labeling or had exceeded expiration dates. Three large bags of shredded cheese showed no opening dates, while a pitcher of white liquid was identified only as a "health shake" without proper labeling.
Particularly concerning were expired condiments found on kitchen shelves. Inspectors discovered caramel sauce and white chocolate sauce containers that had exceeded manufacturer expiration dates. The caramel sauce container lacked a cap and showed dried sauce dripped down its sides.
Spice containers presented additional safety concerns, with only two of eleven containers showing clear opening dates. The inconsistent dating system raised questions about food safety protocols and staff training.
Staff Food Handling Violations
Kitchen personnel failed to follow basic food safety practices during meal preparation. Inspectors observed dietary staff with inadequate hair coverings and poor hand hygiene practices.
One staff member's beard net covered only the chin area, leaving facial hair on the upper lip, cheeks, and neck exposed. Another staff member worked without beard covering entirely, despite facility policies requiring hair coverings in food preparation areas.
Hand hygiene violations occurred when a dietary aide touched their face and adjusted headphones without washing hands before returning to food handling duties. This presents direct contamination risks to resident meals.
Nourishment Storage Problems
Refrigerators designated for resident nourishments showed similar labeling and safety issues. Multiple food items were stored with incomplete identification, including protein shakes labeled only with room numbers but no resident names.
One container from an outside restaurant lacked any date labeling, while a partially used hummus container had no resident identification or storage date. These violations create confusion about food ownership and freshness, potentially leading to consumption of spoiled items.
Missing Hospital Transfer Agreements
Perhaps most concerning for emergency preparedness, the facility completely lacked written transfer agreements with area hospitals certified for Medicare and Medicaid participation. This fundamental requirement ensures residents can receive prompt hospital-level care when needed.
Facility administrators acknowledged during interviews that no transfer agreements existed with local hospitals. This places all residents at risk for delayed emergency transfers and potential barriers to accessing critical care services.
Regulatory Requirements and Standards
Federal regulations require nursing homes to honor resident food preferences as part of person-centered care principles. Facilities must accommodate individual tastes and dietary needs to maintain nutrition, dignity, and quality of life.
Food safety standards mandate proper labeling, storage temperatures, and sanitation practices to prevent contamination and foodborne illness. Kitchen staff must follow professional food handling protocols including appropriate hair coverings and hand hygiene.
Hospital transfer agreements represent essential safety infrastructure, ensuring emergency medical services remain accessible when nursing home care proves insufficient for resident needs.
Facility Response and Expectations
Kitchen management acknowledged multiple violations during inspector interviews. The dietary manager recognized that menu selections sometimes contradicted tray card information and admitted uncertainty about why residents received incorrect meals.
Staff attributed some problems to rushed kitchen operations, inadequate attention to detail, and new employee training gaps. The registered dietician acknowledged that observed practices did not meet facility expectations for food service safety.
Regional food service management emphasized the importance of resident meal preferences, stating that honoring requests reflected the facility's commitment to treating the nursing home as residents' homes.
Quality of Life Implications
These violations extend beyond regulatory compliance to fundamental quality of life issues. Proper nutrition supports physical health, while meal satisfaction contributes to emotional well-being and dignity.
When residents consistently receive unwanted foods or meals they cannot eat due to documented dislikes, nutritional intake may decline. This proves particularly problematic for residents already experiencing weight loss or failure to thrive.
The cumulative effect of repeated meal disappointments can diminish residents' sense of autonomy and control over their daily lives. Food preferences represent one of the few areas where nursing home residents maintain personal choice and individual expression.
Spokane Health & Rehabilitation must address these systematic food service failures through improved staff training, enhanced quality assurance procedures, and better communication systems between dietary and nursing departments. Establishing required hospital transfer agreements remains essential for resident safety and regulatory compliance.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Manor Care Health Services-spo from 2025-04-24 including all violations, facility responses, and corrective action plans.
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