Spokane Health & Rehabilitation: No Full-Time RN Director - WA
That someone else was a Licensed Practical Nurse.
Federal inspectors who visited the facility in April 2025 found that Spokane Health & Rehabilitation had been operating without a full-time Registered Nurse serving as Director of Nursing since at least February 22 of that year. The position is not optional. It is a foundational requirement for any nursing home receiving Medicare and Medicaid funding, and it exists for a specific reason: RNs carry a scope of licensure and clinical training that LPNs do not. Placing an LPN in the functional role of nursing director, even informally, is not a workaround. It is a gap.
The facility's administrator, identified in the inspection report only as Staff A, told inspectors on April 14 that Staff B was the interim Director of Nursing and that the facility had no nurse staffing waivers in place. A waiver would have been the legal mechanism to operate with something other than a full-time RN in that role. Without one, the facility was required to have one. It did not.
What it had instead was a dual arrangement that inspectors found difficult to pin down, and that shifted in its details each time a staff member described it.
The facility's own staff list identified Staff B as holding two positions simultaneously: MDS Coordinator and Director of Nursing. MDS stands for Minimum Data Set, a federally standardized assessment tool that nursing homes use to document resident conditions and care needs. It is detailed, time-consuming work. It is also entirely separate from the clinical oversight, incident review, emergency response, and staff supervision functions that a Director of Nursing is responsible for carrying out.
Staff B described her own situation plainly when inspectors interviewed her on April 23. She said she became the interim DNS in February 2025. She said she worked a 40-hour week. She said her focus was on MDS duties. She said she was not on call after hours. If staff needed to reach someone in an emergency, or if an allegation of abuse or neglect came in after hours, they called Staff C, the LPN serving as Assistant Director of Nursing. Staff B said she was kept in the loop, but she was not the one they called.
Staff C, the LPN, told inspectors on April 18 that she reviewed incident reports after floor staff completed them and tried to implement additional interventions when needed. She also said she did not always have a chance to finish those reviews.
The picture that emerges from those two interviews is of a facility where the person nominally holding the Director of Nursing title was occupied with assessment documentation during business hours and unreachable at night, while an LPN absorbed the remaining responsibilities as best she could, without always having time to complete them.
When inspectors returned to the administrator on April 23 for a follow-up conversation, Staff A confirmed that Staff B had been interim DNS since February 22 and worked roughly 40 hours a week. Asked directly whether she expected Staff B to perform DNS duties for all 40 of those hours, Staff A said Staff B was "available to work 40 hours a week as a DNS if needed." The phrasing is worth noting. Not that Staff B was performing DNS duties. Not that DNS duties occupied her week. That she was available to do them if needed.
Inspectors asked for payroll records covering Staff B's employment from February 2025 through the date of the inspection. No documentation was provided.
The absence of that payroll data matters because it would have shown, concretely, how Staff B's time was actually allocated. If her hours were coded to MDS coordination rather than nursing administration, the facility's own records would have confirmed what Staff B said in her interview: that the DNS role was largely nominal, and the work was landing on Staff C.
What this arrangement meant for residents is not abstract. A Director of Nursing is responsible for overseeing the care that every resident in the building receives. That includes reviewing whether care plans are being followed, whether medications are being administered correctly, whether residents who fall or develop pressure injuries are getting the follow-up they need, whether staff are identifying changes in condition and responding to them. When that oversight function is split between a nurse whose primary focus is documentation and an LPN who acknowledged she couldn't always complete her reviews, residents across the entire facility were subject to a monitoring structure that was thinner than it appeared on paper.
The inspection report cross-references more than twenty additional deficiency tags, covering areas including resident assessments, care planning, medication management, infection control, and accident prevention. The report does not draw direct causal lines between the DNS vacancy and each of those findings. But the structure of the cross-reference is not incidental. Inspectors flagged the Director of Nursing deficiency as affecting many residents, with potential for actual harm, and then pointed toward nearly two dozen other areas of the facility's operation.
None of that is surprising to anyone who has watched what happens when nursing leadership is diluted or divided. The Director of Nursing is the clinical anchor of a nursing home. Staff report to that person. Investigations of abuse and neglect run through that person. The quality of care residents receive, day to day and in moments of crisis, depends significantly on whether that person is actually doing the job.
At Spokane Health & Rehabilitation, the person in that role told inspectors she wasn't doing most of it. The person who was doing most of it told inspectors she didn't always have time to finish. And the administrator, when pressed, described the arrangement as one of availability rather than function.
The facility sits on North Assembly Street in Spokane, a city where the population of adults over 65 has grown steadily for more than a decade. The residents inside its walls depend on the staffing structure that the facility represents to regulators, to families, and to the state of Washington. That structure, for at least two months before inspectors arrived, was not what it appeared to be.
Staff C reviewed incident reports when she could. Staff B was available if needed. Nobody was on call.
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.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 31, 2026 · Our methodology
SPOKANE HEALTH & REHABILITATION in SPOKANE, WA was cited for violations during a health inspection on April 24, 2025.
That someone else was a Licensed Practical Nurse.
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.